HomeMy WebLinkAboutCity of Renton-Additional Insured -COI ISSUED BY WPMIC (1)ACC) ' CERTIFICATE O F LIABILITY INSURANCE DATE(MMIDD/YYYY)
1 02/10/2020THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER. THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESTHISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S), AUTHORIZEDREPRESENTATIVEORPRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the p llcy(`es) must have ADDITIONAL INSURED provisions;or be endorsed.If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement onthiscertificatedoesnotconferrightstothecertificateholderinlieuofsuchendorsements).
PRODUCER CONTACT Elaine PritchardNAME:INTEGRITY UNDERWRITERS INC PHONE 855-454-21 F,xcExt): AIC Nal. 717-551-17945300DERRYSTE-MAIL coi@westernpacificmutual.comADDRESS pacificmutuall.ComHARRISBURG, PA 1 X111
INSURER S AFFORDING COVERAGE NAI+C
INSUREDINSURER
A: Western Pacific M'utual Insurance Company,a RRG 40940
INSURER B:SAPPHIRE HOMES, INC INSURER C:
15805 SE 43RD COURT INSURER D:BELLEV"UE WA 98006 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:EVISION NUMBER:R.THIS IS 7O CERTIFY"THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHERfiHER DOCUMENT WITH RESPECT 7O WHICH THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMSEXCLUSIONSAND,CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
AQDLINSD SUBRINSI
POLICY EDCPLTRTYPEOFINSURANCEFOLICNUMBERPOLICYEFFPOLIWVD1fIMPIaD 'YY MIVIIr{'Y''Y LIMITSCOMMERCIALGENERALLIABILITY
EACH OCCURRENCE 1,000,00ICCLAIMS-MADE OCCUR DAMAGE T RENTED
PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,005
Y WP455I a55 15 1 I a112 1 1 I10112020 PERSONAL&ADS INJURY 1,0001,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
POLICY PRO- F-1JECT LOC PRODUCTS-COMP/OP ACG $ 2,000,000
OTHER;
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO Ea accident
OWNED SCHEDULED BODILY INJURY(Per person) $
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $HIRED NON-OWNEDAUTOSONLYAUTOSONLY PROPERTY DAMAGEPeraccident
UMBRELLA LIA6 OCCUR EACH OCCURRENCEEXCESSLIABCLAIMS-MADE AGGREGATE
DED JRETENTION$
VIrORI{ERS COMPENSATION PER 0TH-AMID EMPLOYERS'LIABILITYITY STATUTE ERIPAITNERIE?SECUTIV'E
Y 1 N R
OFE.L.EACH ACCIDENT $OFFICER/MEMBERMgR EXCLUDED?NIAA
Mandatary in NH)
If yes,describe under E.L.DISEASE-EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORCD 101,Additional Remarks Schedule,may be attached If more space is required)
THE CERTIFICATE HOLDER INDICATED BELOW IS HEREBY INCLUDED AS AN ADDITIONAL INSURED PER THE POLICY'"
CERTIFICATE HOLDER CANCELLATIONATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHEEXPIRATIONDATETHEREOF, NOTICE WILL BE DELIVERED INCITYOFRENTONACCORDANCEWITHTHEPOLICY"PROVISIONS.
ATTN:NATHAN JANDERSIPLANNING DIVISION
1055 SOUTH GRADY WAY AUTHORIZED REPRESENTATIVE
r-D,RENTON,WA 98057
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