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HomeMy WebLinkAboutNegative Split Event Timing LLC - Certificate of Liability Insurance IIA� �® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/29/2023 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 Strategic Risk Transfers Inc. P.O. Box 639 Somers CT 06071 CONTACT NAME: Scott H Sutter PHONE Fax A/c • 508-304-6106 ('VC,No): 508-304-6107 E MAIL ADDRESS: scoff srtins.com INSURE S AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Insurance 18058 License#: 974797 INSURED NEGAT-1 INSURER B : Negative Split Event Timing LLC Performance Training Systems INSURERC: INSURERD: 9715 E Broadway Ave Spokane Valley WA 99206 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 1438638022 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. ILTRNSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDNYYY MM/DDYEXP /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR rof. Liability Y PHPK2520743 2/28/2023 2/28/2024 EACH OCCURRENCE $ 2.000,000 N D PREMISES Ea occurrence $100,000 X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO POLICY LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/OP AGG $2,000,000 Professional Liab. $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON-OX HIRED AUTOS X AUUTOS�ED H&NO Phy Dam Y PHPK2520743 2/28/2023 2/28/2024 COMBINED SINGLE LIMIT Ea accident $ 1,000, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER ^DAMAGE $ X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER TH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City of Pasco is held as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Pasco 525 N 3rd Ave Pasco WA 99301 AUTHORIZED REPRESENTATIVE _ r © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD PHPK2520743 PI-AM-002 (12/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II — WHO IS AN INSURED is amended to include any Certificate Holder, identified as an additional insured, on a Certificate of Insurance issued by Philadelphia Indemnity Insurance Company or our authorized representative, but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are inclusive of and not in addition to the limits of insurance shown in the declarations. Page 1 of 1