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HomeMy WebLinkAbout6563 A�o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 09/04/2024 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 CONTACT Cory Coryell NAME: Fortune Insurance PHONE (253)200-6633 FAX (253)200-6626 (A/C,No,Ext): (A/C,No): 705 S.9th St.#302 E-MAIL cory@fmgins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Tacoma WA 98405 INSURER A: Underwriters at Lloyds,London INSURED INSURER B: West Sound Treatment Center INSURER C: 4060 Wheaton Way,#F INSURER D: INSURER E: Bremerton WA 98310 INSURER F: COVERAGES CERTIFICATE NUMBER: 24-25 GL,Auto 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. INSR LTR IANSD DDL SWVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DDIYYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ 1,000,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y W380FD240101 09/09/2024 09/09/2025 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY n jE& n LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER oTH- WA Stop Gap AND EMPLOYERS'LIABILITY STATUTE X ER Y/N 1,000,000 A ANY CER/MEMBPROPRIETOR/PARTNER/EXECUTIVE N/A W380FD240101 09/09/2024 09/09/2025 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 10 ,00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Each Occurrence $1,000,000 Professional Liability A W380FD240101 09/09/2024 09/09/2025 General Aggregate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Chertificate Holder is an Additional Insured per Blanket AI coverage form E15660 112022 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Bremerton,Municipal Court ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street,Suite 100 AUTHORIZED REPRESENTATIVE Bremerton WA 98337 at9d1 ©1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PHILADELPHIA INDEMNITY INSURANCE COMPANY 1-877-438-7459 ONE BALA PLAZA, SUITE 100 BALA CYNWYD PA 19004 NOTICE OF NONRENEWAL OF INSURANCE Named Insured &Mailing Address: WEST SOUND TREATMENT CENTER 4060 WHEATON WAY STE F BREMERTON WA 98310 ,IUL 2 4 �0?3 Producer: 0120087 BALDWIN INSURANCE GROUP, LLC DBA FORTUNE City of Bremerton MANAGEMEN Risk Management TACOMA WA 9840502 Reference: N/A Policy No.: PHPK2462129 Type of Policy: SA :SUBSTANCE ABUSE -REHABILITATION FACILITIES PKG Date of Expiration: 09/09/2023; 12:01 A.M. Local Time at the mailing address of the Named Insured. We will not renew this policy when it expires. Your insurance will cease on the Expiration Date shown above. The reason for nonrenewal is due to 5 year loss ratio being 128.31 %. This policy provides auto liability coverage. You should contact your agent or any agent concerning coverage through another insurer or the Washington Automobile Insurance Plan. This policy provides fire and extended coverage on your property. You should contact your agent concerning coverage through another insurer or your possible eligibility for coverage through the Washington FAIR Plan. You can contact the Washington FAIR Plan by calling (425) 745-9808 or by writing to 2122 164th Street S.W., Suite 202, Lynnwood, WA 98087. If you have questions or concerns about the actions of your insurance company or agent, or would like information on your rights to file an appeal, contact the Washington state Office of the Insurance Commissioner's consumer protection hotline at 1-800-562-6900 or visit www.insurance.wa.gov. The insurance commissioner protects and educates insurance consumers, advances the public interest, and provides fair and efficient regulation of the insurance industry. Other Party of Interest ,i`" THE CITY OF BREMERTON, MUNICIPAL COUR 345 6TH ST STE 100 BREMERTON WA 98337 Date Mailed: 20th ay of July, 2023 OM«t •� DONNA KENNEDY FORM# CN96970405WA52020 ODEN 3.0.23.06a 0000103-0000212 Copy for Other Interests WACN36NONE APP 07192023MYNY Page 1 of 1