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HomeMy WebLinkAboutTri-Cities Community Health- Sponsorship Agreement Cert of Liability 2023-24TRI_COM_07 TMATTWFWS ,4COR© CERTIFICATE OF LIABILITY INSURANCE `---^" FDATE(MM/DD/YYYY) 10/3/2023 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 have ADDITIONAL INSURED provisions or 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 MIACT Hub International Northwest LLC 2713 N 20Th Ave Pasco, WA 99301 PHONE FAX (A(C, No, Ext): (609) 545-3800 (A/C, Nol:(509) 547-7960 - o I . tonla.matthews@hubinternational.com INSURE S AFFORDING COVERAGE NAIC 0 INSURERA:The Phoenix Insurance Company 25623 INSURED INSURER B: Travelers Indemnity Company of Missouri 40282 INSURER C: Travelers Property Casualty Company of America 25674 Tri-Cities Community Health INSURER D : P.O. Box 1452 Pasco, WA 99301 INSURER E INSURER F : COVERAGES CERTIFICATE NLJMRER: RFVISION NIJMRFR- 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 WD POLICY NUMBER M EFF YY POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR X 630-OX597647 9/30/2023 9/30/2024 EACH OCCURRENCE $ 1'000,000 DAMAGE oc currence) $ 300,000 MED EXP (Anyoneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEST LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ Included B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS SSWN AU�S ONLY ALTOS ONLY X X 81 O-OX601180 9/30/2023 9/30/2024 EIINEDDSINGLE LIMIT $ 1,000,000 BODILY INJURY Per person $ BODILY INJURY Per accident)$ FeOeEandT n MAGE $ C X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CUP-OX601665 9/30/2023 9/30/2024 EACH OCCURRENCE $ 6,000,000 AGGREGATE $ DED I X I RETENTION$ 10,000 5,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AFNY PROPRIETOR/PARTNER/EXECUTIVE ❑ FIC (�AanER/MEMBER EXCLUDED? datory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PEAT ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: TCCH Back To School Health Fair-8/18/23 City of Pasco is an additional insured. Policy forms include: MP9538 0305-Additional Insured, BA2060 0411-Auto Enhancement, BA3002 0618-Auto Primary and Non-contributory and CA0443 1120- Waiver of transfer of rights. City of Pasco 525 N 3rd Ave Pasco, WA 99301 GANGtLLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 csus<- �'y�c2z�-a�c�a ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD