Puget Sount Basketball League 12/6/2017

Lte : 11/14/2017 Time: 1 : 25 PM To : 4252578291 @ 4252578291 Page: 005 AC 0® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/1/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kellie Bendickson NAME: Bell Anderson Agency, Inc. ram. (925)291-5200 FAX No):(425)291-5100 600 SW 39th St, Suite 200 E-MAIL ADDRESS:kellieb@bell anderson.com INSURER(S)AFFORDING COVERAGE NAIC 6 _ Renton WA 98057 INSURER A:Philadelphia Indemnity Insurance _18058 INSURED INSURER B Puget Sound Basketball Leagues INSURER C: 6778 91st Ave SW INSURERD: INSURER E: Seattle WA 98136-1919 INSURER F; COVERAGES CERTIFICATE NUMBER CL179125061 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM!DD/YYYY) (MM!DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT A CLAIMS-MADE X OCCUR PREMISES(Ea occuE ence) 100,000 PHPX1706672 9/1/2017 9/1/2018 MED EXP(Any one person) $ PERSONAL BADV INJURY $ 1,000,000 GENII_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y!N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Everett, its officers, agents and employees are addtional insured general liability, but only if required by written contract or written agreement per the attached endorsement PIAS010 0909 as respects use of facilities. CERTIFICATE HOLDER CANCELLATION (425)257-8291 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett, its officers, agents THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and employees ACCORDANCE WITH THE POLICY PROVISIONS. 802 E Mukilteo Blvd Everett, WA 98203 AUTHORIZED REPRESENTATIVE James Hunt/CM 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1NS025 17014011