Certificate of Liablity Insurance
ACORD. C E RTI FI CAl°E O F LIABI LITIr I fV S lJ RAIV C E DATE (MWDD„YY,r)
12/30/2008
PRODuceR ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC. .ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
, TWO LOGAN SQUARE ,HOLDER. THIS CERTIFICATE DOES NOT AflAflEND, EXTEiVD OR
PHILADELPHIA, PA 19103-2797 !:,ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Attn: Comcast.Certs@marsh.com Fax: 212-948-0360
,
05194 -ALL-GAWU=08-09 COMC BOTHE WA INSURERS AFFORDING COVERAGE NAIC #
iNSUrteD irisuFiERiA: ACE American Insurance Company 22667 ,
COMCAST OF PENNSYLVANIANVASHINGTON/ .
WEST VIRGINIA, LP inisuRER e: ACE Property And Casualty Ins Co 20699
22025 30TH DRIVE SE inisuRER c: Indemnity Ins Co Of North America 43575
BOTHELL, WA 98021
INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD' NpE OF INSURANCE POLICY NUMBER OLICY EFFECTIVE POLICY EXPIRATfON LIMITS
LTR INSR~ • rDATE (MMlDD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY EACH OCCURRENCE ~ 4i 4.900.000
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 4,900,00
A li XSL G2 3749099 12/31/08 'I2/O1/O9 PREMISES(Eaoccurence) I~ 1
I I I CLAIMS MADE I X I OCCUR I MED EXP (My one person) 10,000
I I I PERSONAL 8 ADV INJURY I$ 4,900,000
' X$IOO.OOO SIR GENEwAL AGGREGATE $ 25,000,009
GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AG
PRO_ I q$ 6,000,000
XX
POLICY n JECT n LOC I I I
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 5,000,00
q X ANY Auro ISA H08252361 (AOS) 12/31/08 12/01/09 (Ea accident)
ALL OWNED AUTOS BODILY INJURY ~
SCHEDULED AUTOS ' (Per person)
HIRED AUTOS BODILY INJURY $
NONAWNED AUTOS (Per accident)
PROPERTY DAMAGE
I - (Per accident) $
GARAGE LJABILITY ' AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC I~ I
~ AUTO ONLY: $
AGG
EXCESS/UMBRELLALIABILITY I EACHOCCURRENCE I$ 'rJ,OOO,OO0
B X OCCUR I I cL,aiMS ni►a,DE XOO G24873304 12/01/08 12/01/09 AGGREGATE $ 5,000,000
~ $ 1
DEDUCTIBLE I I$ I
RETENTION $ I IP I
C WORKERS COMPENSATION AND WLR C4 4356697 (AOS) 12/31/08 12/01/09 X WC STATU- OTH- I I
EMPLOYERS' LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE WLR C4 4356776 (CA) 12/31/08 'I Z/O1/O9 .L. EACH ACCIDENT I$ 2,000,000
C OFFICER/MEMBEREXCLUDED? WLRC44356739 (MN) 12/31/08 12/01/09 ~.L.DISEASE-EAEMPLOYE~$ 2,000,000
1 A sPEC1~ PROVisioivs beiow SCF C4 435665A (WI) 12/31/08 12/01/09 L. DISEASE - PO! ICY UMIT $ 2,00O,OOd
OTHER . .
A EXCESS AUTO LIABILITY XSA H08252324 12/31/08 12/01/09 LIMIT $5,000,000
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADOED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY POLICY WHERE REQUIRED BY WRITTEN
CONTRACT WITH THE NAMED INSURED. $100,000 PER OCCURRENCE SELF INSURED RETENTION APPLIES ONLY TO THE ABOVE GENERAL
LIABILITY POLICY.
CERTIFICATE HOLDER CLE-0019463.15-13 CANCELLATION
SHOULD ANY OF- THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE
~ CITY OF SPOKANE VALLEY EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
11707 EAST SPRAGUE, SUITE 106 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IEFT;
SPOKANE VALLEY, WA 99206 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IdND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ic SENTA7NE /1~ J,. ..,.•u-~
r'rT.ri`~~
AoUfTMarsh U5A Ir7
Mary Radaszewski
ACORD 25 (2001108) p ACORD CORPORATION 1988
ACORD. C E R°TI F ICATE OF LIABI LITI( I iV S lJ R41V C E DATE (MM/DD/YYYY)
11 /24/2008
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
TWO LOGAN SQUARE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PHILADELPHIA, PA 19103-2797 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Attn: Comcast.Certs@marsh.com Fax: 212-948-0486
05194 -ALL-GAWU-08-09 COMC BOTHE WA INSURERS AFFORDING COVERAGE NAIC #
INSURED COMCAST OF PENNSYLVANIANVASHINGTON/ iNSURER a: Discover Property And Casualty Ins Co 36463
~
WEST VIRGINIA, LP iNSURER s: ACE Property And Casualty Ins Co 120699
22025 30TH DRIVE SE iNSURER c: Fideliry And Guaranty Insurance Co. 35386 I
BOTHELL, WA 98021
I INSURER D: I
INSURER E: I f
I
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDTypE OF INSURANCE POLICY NUMBER OLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR INSRO rDATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY ~ EACH OCCURRENCE 4 4.900.0001
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEd 4,900,00
A D001Q00054 12/01/08 12101109 PREMISES(Eaoccurence) $ 1
CLAIMS MADE I X I OCCUR I MED EXP (Arry one person) $ 10,000
i I I I PERSONAL 8 ADV INJURY $ 4,900,000
q
~ X$100.000 SIR GENEwAL AGGREGATE I$ 25,000,00
' ~ENERAL AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMP/OP AG~$ 6,000,000
PRO-
POLICY n JECT 71 LOC I I I
AUTOMOBILE UABILITY
COMBINED SINGLE LIMIT $ 1 O,OOO,OO
q X ANY AUTO D001 A00357 (AOS) 12101 /08 12/01/09 (Ea accident)
A ALL OWNED AUTOS D001 A00358 (MA) 12/01 /08 12/01 /09 BODILY INJURY $
A SCHEDULEDAUTOS D001 A00359(TX) 12/01/08 12/01/09 (Perperson)
HIRED AUTOS BODILY INJURY $
NON-0WNED AUTOS (Per accident)
PROPERTY DAMAGE . .
(Per accident) ~
, . . , , . . ' . . '
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT I$ -
F ANY AUTO • OTHER THAN EA ACC I$ " I
AUTO ONLY: $ I
AGG
EXCESSlUMBRELLALIABILITY I EACHOCCURRENCE I$ 5,000,000
B X occuR cuAiMS M,aDE XOO G24873304 12/01/08 12/01/09 I AGGREGATE I$ 5,000,000
I I$ I
DEDUCTIBLE I Is I
RETENTION $ I I-t I
C WORKERS COMPENSATION AND D001 W00433 (AOS) 12/01/08 12/01/09 X WC STATU• OTH- I I
A EMPLOYERS uns~ur~r D001 W00434 (NJ ~ a
) 12/01/08 12101/09 .L. EACH ACCIDENT $ 2,000,~
ANY PROPRIETORlPARTNER/EXECUTIVE
C OFFICER/MEMBER EXCLUDED? D001 W00435 (OR,WI) 12/01/08 12/01/09 ~.L DISEASE - EA EMPLOYEd $ 2,000,000
C SPECIAL PROVISIONS below D001 W00436 (MN) 12/01/0$ 12J01/09 E.L_ DISEASE - POLICY LIMIT I$ 2,QOo,oOd
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CEFtTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY POLICY WHERE REQUIRED BY WRITTEN
CONTRACT WITH THE NAMED INSURED. $100,000 PER OCCURRENCE SELF INSURED RETENTION APPLIES ONLY TO THE ABOVE GENERAL
LIABILITY POLICY.
CERTIFICATE HOLDER CLE-001 94631 5-1 1 CANCEI.LA►TIOiV -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF,SPOKANE VALLEY - EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
11707 EAST SPRAGUE, SUITE 106 30 DAYS WRITTEN NOTICE TO THE CERTIFtCATE HOLDER NAMED TO THE LEFT,
- SPOKANE VALLEY, WA 99206 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLI6ATION OR LIABILITY OF ANY IaND UPON THE INSURER, ITS At3ENTS OR REPRESENTATIVES.
AgAe=sWi~~n~rArnE
Mary Radaszewski - - - - - -
ACORD 25 (2001 /08) O ACORD CORPORATION 1988
~~~~~TANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certficate holder in lieu of such endorsement(s).
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).
DISCLAInAER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representaUve or producer, and the certificate holder, nor does it
affirrnatively or negatively amend, extend ar alter the coverage afforded hsy the policies listed thereon.
Acord 25 (2001/08) Reverse of Page 1
MARSH USA INC.
TWO LOGAN SQUARE
PHILADELPHIA, PA 19103-2797
ATTN: COMCAST.CERTS@MARSH.COM FAX: 21
011874
M-011874
CITY OF SPOKANE VALLEY
11707 E SPRAGUE AVE STE 106
SPOKANE VALLEY WA 99206-6124 191
022164