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Home My WebLink About14 L_Fountain of Hope Ministries International Church Insurance1 10 of 62 1 2 5 9 4 9 00 1 2 5 5 23 5 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 1 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Policy Change Endorsement BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 From 10/01/2023 to 10/01/2024 09/27/23 To report a claim,call your Agent or 1-844-325-2467 Coverage Is Provided In:Policy Number: Policy Period: Endorsement Period: 12:01 am Standard Time at Insured Mailing Location Issue Date Authorized Representative DS 70 27 01 08 FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, 7911 165th Street Ct E LLC Puyallup,WA 98375 1325 4TH AVE STE 2100 SEATTLE,WA 98101 Named Insured &Mailing Address Agent Mailing Address &Phone No. #4 This Policy Change Endorsement Results In A Change In The Charges As Follows: Return Premium $791.00 CHANGES TO POLICY -TRANSACTION $791.00 $6.00 Total Return Charges Certified Acts of Terrorism Return Charges (Included) Note:This is not a bill Description of Change(s) THE FOLLOWING LOCATIONS ARE DELETED:952 SW CAMPUS DR NO 19B1 FEDERAL WAY,WA 98023,12590 SE STARK ST BLDG N PORTLAND,OR 97233CASCADE OFFICE PLAZA LLC IS DELETED AS AN ADDITIONAL INSURED AT 952 SW CAMPUS DR NO 19B1,FEDERAL WAY,WA 98023 See The Revised Declarations and Declarations Schedule 2 10 of 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 2 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Policy Change Endorsement BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 From 10/01/2023 to 10/01/2024 09/27/23 To report a claim,call your Agent or 1-844-325-2467 Coverage Is Provided In:Policy Number: Policy Period: Endorsement Period: 12:01 am Standard Time at Insured Mailing Location Issue Date Authorized Representative DS 70 27 01 08 FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent SUMMARY OF LOCATIONS 0003 300 NW 3rd St,Renton,WA 98057 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy.Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 Commercial General Liability Coverage Form -Occurrence CG 01 81 05 08 Washington Changes CG 01 97 12 07 Washington Changes -Employment-Related Practices Exclusion CG 20 11 04 13 Additional Insured -Managers Or Lessors Of Premises CG 20 22 10 01 Additional Insured -Church Members and Officers CG 21 06 05 14 Exclusion -Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability -With Limited Bodily Injury Exception CG 21 70 01 15 Cap on Losses from Certified Acts of Terrorism CG 21 76 01 15 Exclusion of Punitive Damages Related to a Certified Act of Terrorism CG 24 26 04 13 Amendment of Insured Contract Definition CG 26 77 12 04 Washington -Fungi or Bacteria Exclusion CG 32 21 01 15 Washington Conditional Exclusion of Terrorism Involving Nuclear,Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) 3 10 of 62 1 2 5 9 4 9 00 1 2 5 5 23 5 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 3 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Policy Change Endorsement BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 From 10/01/2023 to 10/01/2024 09/27/23 To report a claim,call your Agent or 1-844-325-2467 Coverage Is Provided In:Policy Number: Policy Period: Endorsement Period: 12:01 am Standard Time at Insured Mailing Location Issue Date Authorized Representative DS 70 27 01 08 FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent POLICY FORMS AND ENDORSEMENTS -CONTINUED This section lists the Forms and Endorsements for your policy.Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 84 99 08 09 Non-Cumulation Liability Limits Same Occurrence CG 88 10 04 13 Commercial General Liability Extension CG 88 77 12 08 Medical Expense At Your Request Endorsement CG 88 87 12 08 Exclusion -Lead Liability CG 88 88 01 16 Professional Exclusion -Pastoral Counseling CG 89 27 10 09 Washington Exclusion -Asbestos CG 91 98 06 15 Disclosure and Notice Concerning Fully Earned and Minimun Premium Endorsements CG 92 48 01 16 Sexual Misconduct or Abuse Exclusion CG 93 81 11 22 Exclusion -Biometric Information Privacy Claim CP 00 10 10 12 Building and Personal Property Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 26 10 12 Washington Changes CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 01 60 03 21 Washington Changes -Domestic Abuse CP 01 79 10 12 Washington Changes -Excluded Causes of Loss CP 10 30 10 12 Causes of Loss -Special Form 4 10 of 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 4 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Policy Change Endorsement BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 From 10/01/2023 to 10/01/2024 09/27/23 To report a claim,call your Agent or 1-844-325-2467 Coverage Is Provided In:Policy Number: Policy Period: Endorsement Period: 12:01 am Standard Time at Insured Mailing Location Issue Date Authorized Representative DS 70 27 01 08 FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent POLICY FORMS AND ENDORSEMENTS -CONTINUED This section lists the Forms and Endorsements for your policy.Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CP 88 00 02 15 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 88 44 02 15 Equipment Breakdown Coverage Endorsement CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 92 01 05 17 Property Anti-Stacking Endorsement CP 92 12 12 20 Cyber Incident Exclusion IL 01 23 11 13 Washington Changes -Defense Costs IL 01 46 08 10 Washington Common Policy Conditions IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) IL 09 35 07 02 Exclusion of Certain Computer-Related Losses IL 09 52 01 15 Cap On Losses From Certified Acts Of Terrorism IL 09 96 01 07 Conditional Exclusion of Terrorism Involving Nuclear,Biological or Chemical Terrorism (Relating to Dispostion of Federal Terrorism Risk Insurance Act) IL 88 56 03 22 Actual Cash Value -Washington 5 10 of 62 1 2 5 9 4 9 00 1 2 5 5 23 5 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 5 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial Property Declarations -Revised BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 1-844-325-2467 DS 70 22 01 08 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent SUMMARY OF CHARGES Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals $345.00 Certified Acts of Terrorism Coverage $10.00 Total Advance Charges:$355.00 Note:This is not a bill 6 10 of 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 6 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial Property Declarations Schedule -Revised BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 1-844-325-2467 DS 70 23 01 08 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent SUMMARY OF PROPERTY COVERAGES -BY LOCATION Insurance at the described premises applies only for coverages for which a limit of insurance is shown.Optional coverages apply only when entries are made in this schedule. 0003 300 NW 3rd St,Renton,WA 98057 Property Description: Characteristics Joisted MasonryConstruction: Your Business Personal Property Coverage Churches and SynagoguesOccupancy: Description Limit of Insurance -Replacement Cost $100,000 Agreed Value -Expires 10/01/2024 Coinsurance 100% Covered Causes of Loss Special Form -Including Theft $1,000Deductible-All Covered Causes of Loss Unless Otherwise Stated $324.00Premium Equipment Breakdown Coverage This Equipment Breakdown insurance applies to the coverages shown for this location.The Equipment Breakdown limit(s)of insurance and deductible are included in,and not in addition to,the limits and deductible shown for the Building, Your Business Personal Property,Your Business Personal Property of Others, Tenants Improvements and Betterments,Business Income and Extra Expense, Business Income Without Extra Expense,and Extra Expense coverages. $9.00Premium 7 10 of 62 1 2 5 9 4 9 00 1 2 5 5 23 5 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 7 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial Property Declarations Schedule -Revised BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 1-844-325-2467 DS 70 23 01 08 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent SUMMARY OF OTHER PROPERTY COVERAGES Identity Theft Administrative Services And Expense Coverage Description Limit of Insurance See Endorsement CP9059 $12.00Premium Property Extension Endorsement Description Property Extension Endorsement $.00 IncludedPremium $345.00CommercialPropertyScheduleTotal: 8 10 of This page intentionally left blank. 9 10 of 62 1 2 5 9 4 9 00 1 2 5 5 23 5 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 9 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial General Liability Declarations -Revised BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 1-844-325-2467 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or OccurrenceBasis: FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION LIMIT General Liability Limits of Insurance Each Occurrence Limit 2,000,000 Damage To Premises Rented To You Limit (Any One Premises)1,000,000 Medical Expense Limit (Any One Person)15,000 Personal and Advertising Injury Limit 2,000,000 General Aggregate Limit (Other than Products -Completed Operations)4,000,000 Products -Completed Operations Aggregate Limit 4,000,000 Explanation of DESCRIPTION PREMIUM Charges General Liability Schedule Totals 1,221.00 Certified Acts of Terrorism Coverage 7.00 Total Advance Charges:$1,228.00 Note:This is not a bill 10 10 of 09/27/23 62125949 POLSVCS 235 NCXHPPNO 001255 10 10INSUREDCOPYPAGEOF Ohio Security Insurance Company Commercial General Liability Declarations Schedule -Revised BKS (24)62 12 59 49 From 10/01/2023 To 10/01/2024 1-844-325-2467 Coverage Is Provided In:Policy Number: Policy Period: 12:01 am Standard Time at Insured Mailing Location To report a claim,call your Agent or FOUNTAIN OF HOPE MINISTRIES (425)885-2283 INTERNATIONAL CHURCH ASSUREDPARTNERS OF WASHINGTON, LLC Named Insured Agent SUMMARY OF CLASSIFICATIONS -BY LOCATION 0003 300 NW 3rd St,Renton,WA 98057 FOUNTAIN OF HOPE MINISTRIES 41650 Insured: CLASSIFICATION - Churches Or Other Houses Of Worship Products-Completed Operations Are Subject To The General Aggregate Limit. 1,000 Premise/Operations 7,005 Square Feet Of Area 166.697 $1,168.00 Included RATED /PER COVERAGE DESCRIPTION PREMIUM BASED ON -PREMIUM Total: SUMMARY OF OTHER COVERAGE COVERAGE DESCRIPTION PREMIUM CG20110413 Additional Insured -Managers or Lessors of Premises $53.00 Commercial General Liability Schedule Total $1,221.00