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HomeMy WebLinkAboutCertificate of InsuranceAC -"R"` CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 05/06/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 CONTACT Gail D'Amour NAME: Allen Financial Insurance Group PHONE (602) 992-1570 (602) 992-8327 A1C No Cxl: RIC,NoI: The Equestrian Group A4tAiL gail@eqgroup.com 12424 N 32nd St Suite 200 DAMAGE TU RENTEU— PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 INSURER(S) AFFORDING COVERAGE NAIC# Phoenix AZ 85032 INSURERA: Capitol Specialty Insurance Corp 10328 INSURED INSURER B Easton Memorial Day Parade INSURER C: PO Box 698 INSURER D INSURER E. Y Easton WA 98925 INSURER F: COVERAGES CERTIFICATE NUMRER- CL195643810 RFVI_CInN NI IMRFR- THIS IS TO CERTIFY THATTHE 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 CONTRACTOR 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/ODS EXP MMraw" LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TU RENTEU— PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 A Y CS19002033 05/24/2019 05/27/2019 GENTAGGREW,TE LIMITAPPLIES PER: POLICY D �Q F LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ Included OTHER Employee Benefits $ AUTOMOBILE LIABILITY C06113INED SINGLE I,IMIrT $ LEa 71ccidon11 BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS P d BODILY INJURY (Per accident) ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ IPer-accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- — AND EMPLOYERS' LIABILITY Y/ N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N /A E L EACH ACCIDENT $ — (Mandatory in NH) If yes, describe under EL DISEASE - EA EMPLOYEE $ — DESCRIPTION OF OPERATIONS below E4 DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is hereby added as additional insured but only in respect to the liability that arises out of the named insured's activities or operations. EVENTEaston Memorial Day Parade VCR 1IF—M1 C rTWI_ JIZIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kittitas County ACCORDANCE WITH THE POLICY PROVISIONS. 205 W 5th Ave AUTHORIZED REPRESENTATIVE Ellensburg WA 98926 �M _ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ........ .. ............. .... . . . . . . . Policy No.: CS19002033-01 Policy Effective Date: 05/24/2019 12:01 a,m. standard time. Policy Change Summary Endorsement Endorsement [Number: 1 �.. Endorsement Effective Date* 05/24/2019 12:01 a.m. standard time. Summary of Changes: Changes below are effective as of the endorsement effective date listed above: Endorsement correcting premises owners on the CG2011 from City of Easton to Kittitas County and Easton School. There is no additional premium for this endorsement. All other terms and conditions of this Policy remain unchanged. CGE 513 08 15 © 2015 CapSpecialty, Inc. All rights reserved. Page 1 of 1 Policy Number: CS19002033-01 Capitol Specialty Insurance Corporation P.O. Box 5900 Madison, WI 53705 AMENDMENT - MINIMUM EARNED PREMIUM This applies to all coverage parts. If this insurance is cancelled at your request, there will be a minimum earned premium retained by us of $ 431 or 100 % of the premium for this insurance, whichever is greater. Cancellation of this insurance for nonpayment of premium is considered a request by the first Named Insured for cancellation of this insurance. The provisions of this amendment apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the minimum earned premium. Therefore as respects audit, at the close of each audit period we will compute the earned premium for that period. If the earned premium is more than the advance premium a bill for the additional premium will be sent to the first Named Insured. If the earned premium is less than the advance premium, the advance premium will apply as the minimum premium, with no return premium payable to you. CGE 126 (03-15) Page 1 of 1 0 2015 CapSpecialty, Inc. All rights reserved Policy Number: CS19002033-01 COMMERCIAL GENERAL LIABILITY CG 20 11 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Railroad St Easton, WA 98925-0698 Name Of Person(s) Or Organization(s) (Additional Insured): Kittitas County and Easton School Additional Premium: $ 0 Information required to complete this Schedule. if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to 1. Any 'occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. However: 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the by law; and applicable Limits of Insurance shown in the Declarations. CG 20 11 04 13 C Insurance Services Office, Inc., 2012 Page 1 of 1 Mandy Buchholz I�IIIIII � UI 1� From: no -reply@ co.kittitas.wa.us Sent: Tuesday, May 21, 2019 1:23 PM To: Mandy Buchholz Cc: Christopher Horner Subject: Prosecutor Service Request 145887 1 Easton Memorial Day Parade S.E.A. Mandy Buchholz, Thank you for submitting a service request. We hope the service was completed to your satisfaction. If you'd like to leave feedback, please use our feedback form. We have closed this request. If you need anything else, please submit another request or renew this. Note: This email was sent from an unmonitored account. Please do not reply to this email. To respond, please update your service request on CAMAS using the link below. Request #45887 - Easton Memorial Day Parade S.E.A. Initial request: Good Morning, Our office received a Special Event application from the Easton Memorial Day Parade, to be held on Saturday May 25, 2019. 1 will be placing this request on the May 7, 2019 Commissioner Agenda for the Board's consideration. Please submit your departments recommendation to me no later than April 30, 2019 by noon. If there are still outstanding issues, please indicate those in writing as well. For specific questions regarding the event I would ask that you contact the applicant directly. Judy Please provide me any updates for Admissions Tax exemption/remit etc. Anything you have. ? Ins. & Endorsements should be coming shortly Thank you! Latest update: A satisfactory endorsement and certificate of insurance have now been provided. I recommend approval. Christopher Horner 5/21/2019 1:22:39 PM Status: Closed Assigned to: Christopher Horner Priority: Soon Due date: 4/30/2019 5:00:00 AM This is an automated email. Please do not reply. Notice: Email sent to Kittitas County may be subject to public disclosure as required by law. message id: 38eb45916c6dcbdac24bb8719d004a14 Mandy Buchholz From: Christopher Horner Sent: Tuesday, May 21, 2019 1:21 PM To: Mandy Buchholz Cc: Jared Auckland Subject: RE: Easton Memorial Day Parade, CS19002033 Good enough. I recommend approval. Thanks! Chris From: Mandy Buchholz Sent: Tuesday, May 21, 2019 1:01 PM To: Christopher Horner Subject: FW: Easton Memorial Day Parade, CS19002033 The latest CMC Deputy Clerk of the Board III Kittitas County Commissioners Office 205 West Fiifli Street Suite #io8 Ellensburg, WA 98926 509-962-7508 (Office) 5o9-962-7679 (Fax) htin:I www.co.kittitas.wa.usI "Try to be a Rainbow in Someone's Cloud" - Maya Angelou From: Easton Memorial Day Parade [mailto:eastonmemorialdayparade@gmail.com] Sent: Tuesday, May 21, 2019 12:43 PM To: Mandy Buchholz Subject: Re: Easton Memorial Day Parade, CS19002033 Mandy, , Attached is the corrected pages of the policy. I hope this gets us squared away. Thanks for your help Cindy On Mon, May 20, 2019 at 3:15 PM Mandy Buchholz <Mand wrote: Bellow.... Is from our Prosecutor. On page 38 of the insurance policy, the "City of Easton" is listed as an additional insured. I didn't see Kittitas County listed anywhere. My recommendation is the "City of Easton" should be replaced with Kittitas County as an additional insured. Chris M0,4 �., !'` .f�., CMC Deputy Clerk of the Board III Kittitas County Commissioners Office 205 West Fifth Street Suite #1o8 Ellensburg, WA 98926 5o9 -962-75o8 (Office) 5o9-962-7679 (Fax) 1-Mv: /Ww-w.co.l ittitas.wa.asE "Try to be a Rainbow in Someone's Cloud" — Maya Angelou From: Easton Memorial Day Parade[mailto:eastonmemorialdayparadg- a o ] Sent: Monday, May 20, 2019 2:44 PM To: Mandy Buchholz; bdavid9Q41gaol.com Subject: Fwd: Easton Memorial Day Parade, CS19002033 ---------- Forwarded message --------- From: Gail D'Amour <Gail(a&,eggroU.com> Date: Mon, May 20, 2019 at 1:48 PM Subject: Easton Memorial Day Parade, CS19002033 To: bdavid9041gaol.com <bdavid9041 aol.co1n> Cc: Tony Ventura <Wentura0�cq&r ucom>,!gqs.toiiiiiciiloi-iLildo.parade@gmail.com <eastonmemorialdayparade a,gm a i l .com> Good Afternoon Ms. Davidson, Please find attached the corrected Certificate of Insurance for Kittitas County: zip code changed to `98926' Please contact us with any questions. Kindest Regards, Gail D'Amour Commercial Underwriting Assistant I AFIG Entertainment Allen Financial Insurance Group I The Equestrian Group 0: 800-874-9191 1 F: 602-992-8327 Alt Fax: 602-992-1570 1 E -Fax: 602-992-8327 12424 N. 32nd Street., Suite 200 1 Phoenix, AZ 85032 gait eggroup.cam I httpsJAww.w.eggroup.com I Give Us Feedback! . .11en Rnanclal Insurance Group Like our business? Leave a review on YELP! Any Quote Provided To You Is Given Without Obligation And Is Not A Contract Or Binder Of Coverage ** To guarantee that coverage is bound, please send in all subjectivities and conditions at least 24 hours prior to the start of your policy. For Weekends, we would need these answered by Friday, 9am EST REMINDER: Coverage cannot be bound or changes in existing insurance coverage or payment schedule may be effectuated by e-mail, unless your request is explicitly acknowledged by your Allen Financial Insurance Group representative. A Please consider the environment before printing this a -mail. This e-mail message and all attachments transmitted with it may contain legally privileged and/or confidential information intended solely for the use of the addressee(s). If the reader of this message is not the intended recipient, you are hereby notified that any reading, dissemination, distribution, copying, forwarding or other use of this message or its attachments is strictly prohibited. If you have received this message in error, please notify the sender immediately and delete this message and all copies and backups thereof. Notice: Email sent to Kittitas County may be subject to public disclosure as required by law messageid:38eb45916c6dcbdac24bb8719d004a14