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HomeMy WebLinkAbout11/15/2011 16 Temporary Emergency Cold Weather Shelters Policy BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT (o Item No. For Meeting of November 15, 2011 ITEM TITLE: A Resolution authorizing and directing the City of Yakima Department of Community and Economic Development to implement a policy regarding temporary emergency cold weather shelters in the City of Yakima, and providing that such policy shall be valid from November 15, 2011, through March 15, 2012. SUBMITTED BY: Michael Morales, Assistant City Manager CONTACT PERSON/TELEPHONE: Joe Caruso, Acting Codes Manager (509- 575 -6257) SUMMARY EXPLANATION: In January of 2007, the City Council adopted a resolution authorizing the Yakima County Homeless Network to use two churches, First Baptist Church and the Vineyard Church for Temporary Emergency Cold Weather Shelters. Council has adopted similar resolutions in 2008, 2009 and 2010. • For the winter of 2011/2012, the Yakima County Homeless Network, in conjunction with the Sunrise Outreach Center of Yakima, has requested to utilize temporary shelters at First Baptist Church (6 Street and Yakima Avenue), Englewood Christian Church (40th Avenue and Englewood Avenue) and Unitarian Church (2 ' Street and Lincoln Avenue). Fifteen sleeping mats will be provided at each location. The proposed temporary emergency shelter program sets minimum standards and requirements for cold weather shelters. Requirements focus on the temporary, volunteer managed characteristic of these shelters. The floor plan configuration within each of the facilities will be reviewed, inspected and approved by the Building /Fire official. Resolution X Ordinance_ Contract _ Other (Specify) Funding Source APPROVAL FOR SUBMITTAL: / &I / , . Cit Mana•er STAFF RECOMMENDATION: Adopt Resolution BOARD /COMMISSION /COMMITTEE RECOMMENDATION: • COUNCIL ACTION: • RESOLUTION NO. R- 2011 - A RESOLUTION authorizing and directing the City of Yakima Department of Community and Economic Development to implement a policy regarding temporary emergency cold weather shelters in the City of Yakima, and providing that such policy shall be valid from November 15, 2011 through March 15, 2012. WHEREAS, the City of Yakima, in conjunction with the Yakima County Homeless Network, is aware that there is within the City of Yakima a population of homeless persons who may require temporary emergency shelter from cold weather; and WHEREAS, owners of various buildings, including churches, located within the City of Yakima have indicated that they are willing and able to provide temporary emergency shelter; and WHEREAS, the City of Yakima currently has no municipal code provisions, whether under the zoning, buildings, fire, or other codes, expressly allowing, authorizing, or regulating the use of such structures as temporary emergency shelters; and WHEREAS, the City of Yakima Department of Community and Economic Development has endeavored to create interim policy guidelines to address and regulate temporary emergency shelters; and WHEREAS, the Yakima City Council finds and determines that it is in the public interest to adopt the resolution set forth herein; NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Yakima: The City of Yakima Department of Community and Economic Development is hereby authorized and directed to implement a temporary emergency cold weather shelter policy. The proposed policy and application materials are attached hereto as Exhibit A, which exhibits are hereby incorporated by this reference as if fully set forth herein. This resolution shall be effective after its adoption and for a period expiring on March 15, 2012. ADOPTED by the City Council this 15 day of November 2011. Micah Cawley, Mayor ATTEST: City Clerk • 11110 s reac DT: 10/27/2011 TO: City of Yakima CC: Joseph Caruso FR: Dave Hanson RE: Extreme Winter Weather Shelter for the Homeless } ii As of this date, all Shelter opening criteria set forth from city and county officials have been satisfied in the 1st Baptist, Englewood Christian Church, and the Unitarian Church facilities. Floor plans are at- tached and insurance documentation is enclosed for all three facilities. We will limit the above mentioned facilities to 15 mats each again this year. This year's project will run in mirror image of last year's program. • Sunri Out rc.lr C titer ni Yaki�rr 221 E TALK Jr. Rhvd. Yakima, WA 98901 509.225.9310 office 509.895 -7775 fax ACCPREP CERTIFICATE OF LIABILITY INSURANCE DATE '7/19/2011 T • HIS 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, curtain 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 .N Lisa Daley PH APE E Conover Insurance, Inc. fA�_Na.IEd1: (509) 965 -2090 1 ,„ (509)M-3454 125 N. 50th Ave. jEpa14pg�g .liead @oonoverineuraace.com P.O. Box 10088 aR,og roy{)0O57416 I Yakima WA 98909 -1088 INSURER(8) AFFORDING COVERAGE •_ NAIC II INSURED INSURERA:Great American Assurance CO mum a:Great American Ins. Companies Sunrise Outreach Center of Yakima IAN uRRER c, 1 P 0 Box 10413 INSURER 0: – – INSURER E : Yakima WA 98909 INSURER F; COVERAGES CERTIFICATE NUMBER:CL1171913745 REVISION NUMBER: I THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i INDICATED. NOTIMTHSTANDING 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 I6 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ary1KIIIISrj POLIC'VEFT— POLICY EXp UNITS WEIR NUMBER (MMJDO'YYYY) 1MM TYPE OF WBURANCE INSR 1Ai1J(! GENERAL UABILITf EACH OCCURRENCE S 1 ,000,000 PREMISES (Eps SW 5 _ 100,000 X COMMERCIAL GENERAL IAB1LITY 7/21/2011 7/21/2012 5,000 ClAtA16•MADE LXi OCCUR PAC863942801 MED EXP (Arty one Pelson) 5 PERSONAL 6 ACV INJURY _ 5 1,000,000 ' GENERAL AGGREGATE 5 2,000,000 GENT. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 ^ I PRO• _ $ X POLICY JECT LOC – COMBINED SINGLE LIMIT 0 ALITOMOBILELIABILITY 5 1,000,000 (Ea accident) • ANY AUTO BODILY INJURY (Per parson) $ A — ALL OWNED AUTOS CAP863942$01 7/21/2011 7/21/2012 BODILY INJURY (Per eoddenl) $ X SCHEDULED AUTOS PROPERTY DAMAGE. $ (Per accident) X HIRED AUTOS Medical payments $ 5,000 NON -OWNED AUTOS • — Unlneured motorlat combinad $ 1 , 000 , 000 UMBRELLA LIAM OCCUR EACH OCCURRENCE 5 EXCESS LIAR cumms•MADEi AGGREGATE _• � $ DEDUCTIBLE fff $ 1 RETENTION 5 Y ,C &TATU B WORKERS COMPENSATION X .I T I A A U- X I TH- . O EH AND EMPLOYERS' LIABILITY _ EL EACH ACCIDENT $ 1,000,000 ANY PROP Y N 7/21/2011 7/21/2012 OFFICE Is H) EXCLUDED'? $$98196570 E.L DISEASE .. EA EMPLOYEE 5 1,000,000 (Mandatory In NH) 11411 14.1• da,o*s under E.L. DISEASE - POLICY LIMIT 5 1, 000 , 000 ON OF OPERATIONS below DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (AUach ACORD 101. Additional RanertsSchedule, If more space Is required) Re: Extreme Weather Shelters City of Yakima, its agents, employees, elected and appointed officials and volunteers are named as additional insureds as required by written contract or agreement, per the following social services agency i general liability broadening endorsement CG 82 24 12 01. • ' i 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 Yakima • Attn : Joseph Caruso AUTHORIZED REPRESENTATIVE • 129 N. 2nd St Yakima, WA 98901 Sherry Lyach /LSSAD ACORD 26 (2009!09) ®1988 -2009 ACORD CORPORATION. All rights reserved. INS026 moos) The ACORD name and logo are registered marks of ACORD • S C 0 Sl*07/19/10•PAC8639 Oi 486177029 `D1B I rAN ASSURANCE CUI'Y ' 0178234 GREAT AMER - Aernlnletrative Mena 550 Walnut Street Clnernnetl, Onlo 45201 GREATAMERJCAN. Tel: 1.513- 95a -5oo0 CG 82 24 ( rwuo.rtta+wn (Ed. 12 01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. r SOCIAL SERVICE AGENCY GENERAL UABiLIITY BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART , 1. The following provision is added to SECTION (2) forded respe pe t the insurance af- Insured 11 - WHOM AN INSURED i• identified in Paragraph A.(1) of 5. AUTOMATIC ADDITIONAL INSURED(S) this endorsement, the following . additional provisions apply: a. Additional insured - Manager or ' Lessor of Premises (a) This insurance applies only to liability arising out of the ell This policy is amended to include ownership, maintenance or as an insured any person or or- use of that portion of the ganization (hereinafter called Ad- premises leased to you. . ditional insured) from whom you �) The Limits of Insurance ap- 0 lease or rent property and which plicable to the Addi p - requires you to add such person P or organization as an Additional • sured are the lesser of those Insured on this policy under • specified in the written con - tract or agreement or in the (a) a written contract; or Declarations for this policy and subject to all the terms, • (b} an oral agreement or con- conditions, and exclusions ' tract where a Certificate of for this policy. The Limits of Insurance showing that per- Insurance applicable to the son or organization as an Additional Insured are inclu- Additional Insured has been sive of and not in addition to issued; the Limits of Insurance shown in the Declarations. but the written or oral contract or agreement must be an "insured (ol In no event shall the cov- contract," and, erages or Limits of insurance in this Coverage Form be in- (I} currently in effect or be- creased by such contract come effective during the term of this policy; and Id) Coverage provided herein is . excess over any other valid (ill executed prior to the "bodily and collectible insurance injury, "property damage," available to the Additional In- ''personal and advertising in- sured whether the other in- jury.' surance is primary, excess, i includes copyrighted material of Insurance Service Office with its permission. • Copyright, Insurance Services Office, inc., 2001 • ( Page°- 4-- ot- 41...._.--•-- ..---._...._..__. �... ____.__�- _..�._.._- .._...�_.__. i^t+ 82 2 tEd: 1 CIO 91 x- u • S1•U / /1y /1U•rAC.tlbJ4l4L0•Ul vaatllULW '1.)16 unIkAimML L.VrT 0178234 GREAT AMER IC I ASSURANCE CO - 4110 contingent or on any other tomarily provided by the basis unless a written con- policy forms specified in and tractual arrangement specifi- required by the contract cally requires this insurance to be primary. (c) in no event shall the coy- erages of Limits of Insurance (3) This insurance does not apply to: In this Coverage Form be in- creased by such contract (e) Any "occurrence" or offense which takes place after you c. Additional Insured - Contractual cease to be a tenant in that Obligations premises. (1) This policy is amended to include (b) Structural alterations, new as an Insured any person or or- ' construction or demolition ganization (hereinafter called Ad- operations performed by or diticmal insured) that you are re- on behalf of the "Additional quired by a written "insured con- Insured." tract" to include as an Insured, subject to all of the following b. Additional Insured - Funding provisions Sources la) Coverage is limited to liability (1) This policy Is amended to include arising out of: as an Insured any Funding Source which requires you in a written (i) your ongoing oper- contract to name the Funding ations performed for Source (hereinafter called Addi- such Additional Insured; tonal Insured) as an Insured but or only with respect to liability aris- ing out of your premises, "your (II) that Insured's financial work" for such Additional Insured, control of you or or acts or omissions of such Ad- ditionat Insured in connection with (iii) the maintenance, opera- . the general supervision of "your tion or use by you of work" and only to the extent set equipment leased to forth as follows: you by such Additional Insured; or (a) The Limits of Insurance ap- plicable to the Additional In (iv) a state or political sub - sured are the lesser of those division permit issued . specified in the written con- to you. tract or agreement or in the Declarations for this policy (b) Coverage does not apply to and subject to all the terms, any "occurrence" or offense: conditions, and exclusions for this policy. The Limits of , (1) which took place be- Insurance applicable to the fore the execution of, Additional Insured are inclu- or subsequent to the sive of and not in addition to completion or expire- the Limits of Insurance tion of, the written In- ' shown in the Declarations. sured contract", or (b) The coverage provided to (ii) which takes place after the Additional Insureds) is you cease to be a ten- not greater than that cus- ant in that premises. Includes copyrighted material of Insurance Service Office with its permission. Copyright, Insurance Services Office, Inc., 2001 -- -r�r'; - a� - •�a •r�-ra- --i• din t•r• �;c . ______ - _ __ ..-- . _ . _ . _ .Panic . ... . ...._._..... — .._....— — ._...�. __ ___ L - . { C 51 007/19/10 "PAC8639428 01 488177029 '- /5 ORIGINAL COPY 0178234 GREAT AMEr - .AN ASSURANCE CO (c) With respect to architects, work" done under a contract for that engineers, or surveyors, person or organization and included in coverage does not apply to the "products- completed operations "Bodily Injury," "Property hazard." Damage," "Personal and Ad- vertising Injury" arising out 3. NON -OWNED OR CHARTERED WATER- S of the rendering or the fail- CRAFT • ure to render any profes- 4 sional services by or for you Section 1 - Coverages, Coverage A, Item Including: 2.g.(2) is replaced with: (1) the preparing, approv- (2) A watercraft you do not own that is: Ing, or failing to pre - pare or approve maps, (e) less than 51 feet long; and drawings, opinions, re- ports, surveys, change (b) not being used to carry persons or orders, designs or property for a charge. . specifications; and 4. BROADENED PERSONAL AND ADVERTISING ■ (11) supervisory. inspection, INJURY or engineering services. Unless "Personal and Advertising Injury" is ex- If an Additional Insured endorsement is at- eluded from this policy tached to this policy and specifically names a SECTION V - DEFINITIONS Item 14, is re- , person or organization as an Insured, then the placed by: coverage in Section 11 - WHO IS AN INSURED 5. Automatic Additional Insured(s) 14. "Personal and Advertising injury" means does not apply to that person or organization. i including consequential "bodily in- . arising out of one or more of the 2. BLANKET WAIVER OF SUBROGATION following offenses: ' SECTION IV - COMMERCIAL GENERAL a. false arrest, detention or imprison - LIABILITY CONDITIONS, item 8. Is replaced ment; with: b. malicious prosecution; B. Transfer of Rights of Recovery Against Others to us and Blanket Waiver of c. the wrongful eviction from, wrongful Subrogation entry into, or invasion of the right of . private occupancy of a room, dwelling a. If an Insured has rights to recover all or premises that a person occupies by or part of any payment we have made or on behalf of its owner, landlord or under this Coverage Part, those rights lessor; are transferred to us. The insured must do nothing after loss to impair them. d. oral, written, televised, videotaped. or At our request, the insured will bring electronic publication of material, in "suit" or transfer those rights to us and any manner, that slanders or libels a help us enforce them person or organization or disparages a person's or organization's goods, pro - b. If required by a written "insured con- ducts or services; tract', we waive any right of recovery we may have against any person or e. oral, written, televised, videotaped. or organization because of payments we electronic publication of material, in make for injury or damage arising out any manner, that violates a person's of your ongoing operations or "your right of privacy; or • Includes copyrighted material of Insurance Service Office with its permission. 410 Copyright, Insurance Services Office, Inc., 2001 - " -24- 1Ed:- 12/011 -XS— _.,.. --- ..__- .--- - -..._— rem -3`of- el -_ --------------- _ - C • S1.07/19/10*PAC86;39428 -01 488177029 *D /B ORIGINAL COPY III 0178234 GREAT AMERIr 1 ASSURANCE CO f. mental injury, mental anguish, humili- Subject to 5. above, the Damage to Pram- ation, or shock, if directly resulting ises Rented to You Limit is the most we from Items 14.a, through 14.e. will pay under Coverage A for damages because of "property damage" to your g. the use of another's advertising idea in building, or to personal property of others your "advertisement'; or in your care, custody and control while at premises rented to you or temporarily h. infringing upon another's copyright, occupied by you with permission of the trade dress or slogan in your "adver- owner, arising out of any one fire. tisement" The Damage to Premises Rented To You 5. MENTAL INJURY, MENTAL ANGUISH, Limit is replaced by the following Damage HUMILIATION, OR SHOCK INCLUDED IN to Premises Rented To You Limit BODILY INJURY DEFINITION The Damage to Premises Rented To You • Section V - Definitions, Item 3. Is replaced Limit is the greater of: with: i1) 5300,000; or 3. "Bodily injury" means physical Injury, sick- (2) the amount shown in the Declarations Hess, or disease, including death of a per for Damage to Premises Rented to son. "Bodily injury " also means mental in- You Limit jury, mental anguish, humiliation, or shock if directly resulting from physical injury, B. This provision is subject to all the terms sickness, or disease to that person. of SECTION III - LIMITS OF INSURANCE. 6. MEDICAL PAYMENTS • C. This provision 5. does not apply if Damage to Premises Rent to You Liability of COV- A. The Medical Expense Limit in Paragraph 7. ERAGE A (SECTION 1) is excluded either of SECTION III - LIMITS OF INSURANCE by the provisions of the Coverage Part or is replaced by the following Medical Ex- by endorsement panne Limit 110 The Medical Expense Limit provided by 8. SUPPLEMENTARY PAYMENTS this policy shall be the greater of A. In the SUPPLEMENTARY PAYMENTS - COVERAGES A and B provision, Item 1.b., a. 810,000; or and 1.d are replaced with b. The amount shown in the Declarations 1.b. Up to 5500 for cost of bail bonds for Medical Expense Limit required because of accidents or traf- fic law violations arising out of the use B. This provision 7. Is subject to all the terms of any vehicle to which the Bodily In- of SECTION 111 - LIMITS OF INSURANCE. jury Liability Coverage applies. We do not have to furnish these bonds. C. This provision 7. does not apply if COVERAGE C. MEDICAL. PAYMENTS is t.d. All reasonable expanses incurred by excluded either by the provisions of the the Insured at our request to assist us Coverage Fart or by endorsement - in the investigation or defense of the claim or "suit" including actual Toss of 7. DAMAGE TO PREMISES RENTED TO YOU earnings up to $500 a day because of LIMiT time off work. A. SECTION III - LIMITS OF INSURANCE, This endorsement does not change any other Item 6. is replaced with: provision of the policy. Includes copyrighted material of Insurance Service Office with its permission. Copyright, insurance Services Office, Inc., 2.001 ..._--`- Ifl'wi:n' T":;Z'- 75'1-' . __.. _.._ ____.._ ._•__.__..__.- ipt First Baptist /Comunidad Cristiana � V� Building anew community in Yakima jaklil yr ��` 515 East Yakima Avenue — Yakima, Washington 98901 -2701 (509) 248 -4434 FAX (509) 248 -4435 www.fbcyakima.org • • To whom it may concern: Rev. David W. Roberts Senior Pastor The First Baptist Church/ Comunidad Cristiana has agreed to host the extreme "ee yal°ma ° ° weather emergency shelter for homeless men from November 15, 2011 through March 15, 2012. Rev. MaauelLugrrin Pastor • S1nr y m.LuquinV lbcyakimaorg David Roberts • • • Dr. Estelle Schock Missionary Emeritus • 411 4. • . . .. ; . . . I , . . ..., • TV g..00rn ,. . ., . „1 . . 1 1 GiSE Tiq 3tcs 1 [ 5 rokA6E . , 1111111111MAD KIrcHCN -Pocoogig6 . 111. 4- 6(0 boo.N) Iro . . , 1 5f bCO35f- , , .. . . 11 . i 1 . 1 ! . , H • ' . , i . • ' 1_, _. • S Ac .-- ° CERTIFICATE OF LIABILITY INSURANCE DATE r ' • THIS CERTIFICATE I8 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TH$ ISSUING INSURER($), 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 CONTACT NA HRAIher R Wolff Church Mutual insurance Company ( . Ho. Belk 1- 800 -554 -2642 Ootion 1 I IAA. Nor. 855 -264 -2329 3000 Schuster Lane vie Merrill WI 54452 INBURER(S) AFFORDING COVERAGE NAM a INSURER A: f'hurch Mutual Ins;uranraf;ompnny 1RTR7 INSURED INSURER a : FIRST BAPTIST CHURCH OF THE CITY OF NORTH YAKIMA mauREsc: } INSURER D: 615 E YAKIMA AVE INSURER E YAKIMA WA 98901 -2701 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 70 CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVIBTHSTANOIND ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT' MTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L7R TYPE OF INSURANCE "ADDL - BR - POUCYEFF POLICY EXP FOR WVD POLICY NUMBER IMM4IWYYYY1 IMMI00IYYYYI LIMITS GENERAL LABILITY - EACHOCCURREN S inn nnn X COMMERCIAL GENERAL UAINUTY PREMlSES (Ea odcunencel 8 CLAUr -MADE © OCCUR MED EXP WIT onsMaud $ 1n_nnn A _ 0047262 -02 - 303805 02/19/2011 02/19/2014 PERSONAL S ADV INJURY $ 1 nnn.000 GENERAL AGGREGATE $ 3.000.000 GEM AGGREGATE UMITAPPUES PETt � POLICY rga f LOC PRODUCTS- COMPXWAGG a 1 �In1)ntM S AUTOMOBILE LIABILITY F t"-, / CAM d aiN):D I � WGLE LIMIT ANY AUTO t J BODILY INJURY (Per per on) S III — ALL OWNED r-- SCHEDULED _ _ AUTOS AUTOS BODILY INJURY (Per occident) a HIRED AUTOS ^ ON-OWN ED PROPERTY DAMAGE (Per accident) a a UMBRELLA. LIAR OCCUR E n EACH OCCURRENCE S EXCESBUAB CLAIMS-MADE • AGGREGATE $ DEO 1 I RETENTION a — S WORKERS COMPENSATION I Y LIIMIT I LIMITS 1 ER AND EMPLOYERS' LIABILITY ANY Y/N W OFFICE/MEMBER EXCLUDED? n N ! A n EL EACH ACCIDENT (MindaLoyInNH) EL_ DISEASE - EA EMPLOYEE a II" describe ender - _ EJ- DISEASE - POUCYUNIT S nI ,' DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Renuka Scheduled/ more alma la required) Evidence of Liability Insurance for Extreme Weather Shelter Program from Nov. 15, 2011 - February 29, 2012 from 530pm - 6:30am at 515 E Yakima Ave, Yakima, WA 98901. 519 • CERTIFICATE HOLDER CANCELLATION City of Yakima SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 129 N 2nd Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVEREO IN Yakima, WA 98901 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WI • • ©1988 2010 ACORD CORPO 1 e All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD III • . . _______ . . • \LI ENGLEWOOD CHRISTIAN CHURCH (Disciples of Christ) 511 N. 44 Avenue, Yakima, Washington 98908 -2698 Office Phone: (509) 966 -6550 Dr. David C. Helseth, Senior Pastor • October 25, 2011 Yakima City Council Yakima City Hall 129 North Second Street • Yakima, WA 98901 • • To Whom it May Conceal: • This letter is to advise you that Englewood Christian C3nrch, located at 511 North 44 Avenue, Yakima, WA 98908, has the intent to open the men's shelter beginning November 15, 2011 through March 15, 2012. Attached please find copies of our Liability Insurance. Should you have comments or questions, please feel free to contact me at the church office, (509) 966 -6550. Thank you. Sin e y, aeiz David C. Helseth Senior Pastor jld I A congregation of the Christian Church (Disciples of Christ) I • • 1 I CHURCH MUTUAL INSURANCE COMPANY • UMBRELLA LIABILITY POLICY SCHEDULE OF UNDERLYING INSURANCE POUCY.NUMBER: 0039660 -81- 303194 TYPE OF INSURANCE LJMIT OF INSURANCE GENERAL LIABILITY $ 3,000,000 GENERAL AGGREGATE $ 1,000,000 PRODUCTS/COMPLETED OPERATIONS AGGREGATE $ 1,000,000 EACH OCCURRENCE (BODILY INJURY AND PROPERTY DAMAGE $ 1,000,000 PERSONAL AND ADVERTISING INJURY COMPANY PROVIDING THE INSURANCE: CHURCH MUTUAL INSURANCE COMPANY POLICY PERIOD: 02/01/11 TO 02101/14 COUNSELING PROFESSIONAL LIABILITY $ 1,000,000 EACH CLAIM $ 3,000,000 AGGREGATE COMPANY PROVIDING THE INSURANCE: CHURCH MUTUAL INSURANCE COMPANY • POLICY PERIOD: 02/01/11 TO 02/01/14 HIRED AND NONOWNED AUTOMOBILE LIABILITY $ 1,000,000 EACH OCCURRENCE $ 3,000,000 AGGREGATE COMPANY PROVIDING THE INSURANCE CHURCH MUTUAL INSURANCE COMPANY POLICY PERK: 02/01/11 TO 02/01/14 WORKERS' COMPENSATION STATUTORY EMPLOYERS LIABILITY (STOP GAP) COVERAGE $ 1,000,000 BODILY INJURY BY ACCIDENT -EACH ACCIDENT $ 1,000,000 BODILY INJURY BY DISEASE-EACH EMPLOYEE $ 1,000,000 BODILY INJURY BY DISEASE -POUCY LIMIT COMPANY PROVIDING THE INSURANCE CHURCH MUTUAL INSURANCE COMPANY POLICY PERIOD: 02/01/11 TO 02/01/14 • • Chug Mutu - irsrr�trct ,WP H UMB SCHED (02 -88) 1 ISSUED DATE 02/24/1 1, • i 'AD POLICY NO.: 0089880 -61 303194 ITEM 6. SCHEDULE OF UNDERLYING INSURANCE (SEE ATTACHED SCHEDULE): REM 7. PREMIUM; IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS IN T1118 POLICY, • WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLCY. 050.00 DUE AT INCEPTION. PREMIUM SUBJECT TO ADJUSTMENT AT EACH ANNIVERSARY. ITEM 8. AGENT: 03-203 JOE DAVIS SPOKANE VALLEY OFFICE- . 16407 E MISSION AVE STE 485 SPOKANE VALLEY, WA A9037 (800) .554 -2842 • • j . • • • • • • • corrrisc moth mutual cimPerri. 199a Mewen capr+ebNd materiel Of kw., Sam wee. me, *IA Ies puetleamn. cantle*. meweeea San Oldee. km. mas a 1904 LIMB D (09 -99) 2 ISSUED DATE: 02/24/11 1 t „...____. ....________, Mutual Company. Nonassessabla Policy CHURCH MUTUAL INSURANCE COMPANY 3000 Schuster Lane, P.O. Box 357, MerrIll, WI 54452 UMBRELLA LIABILITY POUCY DECLARATIONS PAGE • EXCESS INSURANCE POUCY NUMBER: 0039860-81-303104 ITEM 1. NAMED INSURED AND ADDRESS: • ENGLEWOOD CHRISTIAN CHURCH 519 N 44TH AVE YAKIMA WA 98908 -2698 • ITEM 2. POLICY PERIOD: FROM 02/01/11 TO 02/01/14 0039860 -81- 878874 12:01 A.M. STANDARD TIME AT YOUR ADDRESS SHOWN ABOVE. (RENEWAL 09 ITEM 3. THE NAMED INSURED IS: RELIGIOUS INSTITUTION ITEM 4. LIMITS OF INSURANCE: • GENERAL AGGREGATE LIMIT - (ANNUAL) $ 1,000,000 EACH OCCURRENCE LIMIT- (BODILY INJURY AND PROPERTY DAMAGE COMBINED) $ 1,000,000 • • (ANNUAL) • PERSONAL AND ADVERTISING INJURY LIMIT - (COMBINED) $ 1,000,000 SELF- INSURED RETENTION $ 10,000 (EACH OCCURRENCE OR OFFENSE NOT COVERED BY UNDERLYING INSURANCE) • ITEM 5. FORMS AND ENDORSEMENTS WHICH APPLY TO THIS POUCY: UMB 8000 (02 -88) MUTUAL POUCY CONDITIONS UMB 8001 01 -04 UMBRELLA LIABILITY POLICY LIMB 8195 -88 NUCLEAR ENERGY UABIUTY EXCLUSION - BROAD FORM UMB 8117 02 -88 ASBESTOS UMB 8121 09-94 LEAD UABILITY - UMB 8128(01 -08) EXCLUSION OF CERTIFIED ACTS OF TERRORISM UMB 8133(05 -03) WAR LIABILITY EXCLUSION UMB 8134WA(08 -06) WASHINGTON FUNGI OR BACTERIA EXCLUSION UMB 8203(02-88) COUNSELING PROFESSIONAL LIABILITY UMB 8204(0 -88 EMPLOYERS' LIABILITY- FOLLOWING FORM . UMB 8210(03 -03 ACQUIRED AUTOMOBILES ENDORSEMENT • UMB 8214(12-08 AMENDATORY ENDORSEMENT-PERSONAL INJURY UMB 8215(1 -07 BODILY INJURY DEFINITION • UMB 8218(12 -07) CORPORATE ENTITY ENDORSEMENT UMB 8841(12-0 AMENDATORY ENDORSEMENT - WASHINGTON UN 580(01-94) WASHINGTON POLICY JACKET IIIII . u urr tu UMB 0(09-99) 1 MUM! LOI►AA? ISSUED DATE: 02/24/11, • PROFESSIONAL LIABILITY COVERAGE PART DECLARATIONS PAGE • POUCY NO.: 0039680-02-303193 ITEM t COVERAGE DESCRIPTION: COVERAGE UMIT OF INIZURANCE • COUNSELING PROFESSIONAL LIABILITY • EACH CLAIM $ 1,000,000 AGGREGATE $ 3,000,000 SCHEDULE OF POSITIONS COVERED • "SCHEDULE OF POSITIONS COVERED" - "EMPLOYEES AND VOLUNTEERS ACTING UNDER YOUR DIRECTION AND CONTROL AND WITHIN THE SCOPE OF HIS OR HER DUTIES AS SUCH." • ITEM 2. ENDORSEMENTS: NONE • 1. V 1115 I* [/806th • A 001 PR(10 -59) - WA PAGE 1 ISSUED DATE: 0 ■ • • { GENERAL LIABILITY COVERAGE PART • DECLARATIONS PAGE POLICY NO.: 0039660-02303193 • ITEM 1. LIMITS OF INSURANCE: GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS - COMPLETED $ 3,000,000 OPERATIONS AND SEXUAL MISCONDUCT OR SEXUAL MOLESTATION) PRODUCTS - COMPLETED OPERATIONS AGGREGATE UMIT $ 1,000,000 EACH OCCURRENCE LIMIT (BODILY INJURY AND PROPERTY DAMAGE $ 1.000,000 • COMBINED) PERSONAL AND ADVERTISING INJURY LIMIT (COMBINED) $ 1,000,000 MEDICAL EXPENSE UMIT - ANY ONE PERSON (OTHER THAN SEXUAL MISCONDUCT OR SEXUAL MOLESTATION) $ 10,000 PROPERTY DAMAGE LEGAL LAABIUTY - ANY ONE OCCURRENCE $ 300,000 , SEXUAL MISCONDUCT OR SEXUAL MOLESTATION LIMIT (COMBINED) - ALL • LOCATIONS AND OPERATIONS EACH CLAIM LIMIT $ 300,000 AGGREGATE LIMIT $ 300,000 SEXUAL MISCONDUCT OR SEXUAL MOLESTATION MEDICAL EXPENSE LIMIT ANY ONE PERSON $ 10,000 AGGREGATE LIMIT $ 50,000 • LEGAL DEFENSE COVERAGE UMIT EACH DEFENSIBLE INCIDENT UMIT $ 5,000 AGGREGATE LIMIT $ 18,000 CATASTROPHIC VIOLENCE RESPONSE PER PERSON LIMIT $ 50,000 EACH VIOLENT INCIDENT LIMIT $ 300,000 VIOLENT INCIDENT AGGREGATE LIMIT $ 3Q0,000 EMPLOYERS LIABILITY (STOP GAP) COVERAGE BODILY INJURY BY ACCIDENT -EACH ACCIDENT $ 1,000,000 ' BODILY INJURY BY DISEASE-EACH EMPLOYEE $ 1,000,000 BODILY INJURY BY DISEASE-AGGREGATE UMIT $ 1,000,000 ITEM L DESCRIPTION AND CLASSIFICATION OFPREMISES AND OPERATIONS: ALL PREMISES AND OPERATIONS UNLESS EXCLUDED IN ITEM 3 BELOW. NONE ITEM 3. EXCLUSION ENDORSEMENTS: un� u�tu • uIAUJ MI PINY A 001 G(03 -04) - WA . PAGE 1 ISSUED DATE: 02!24/11 POLICY NUMBER EFFECTIVE: 02!01/11 od'3964 - oz- 3&3193 • ENGLEUVOOO CHRISTIAN CHURCH (THE) 511 N44THAVE YAKIMA WA 890B -2698 • 03 • 410 YOUR REPRESENTATIVE: JOE DAVIS • SPOKANE VALLEY OFFICE 15407 E MISSION AVE STE 465 SPOKANE VALLEY WA 99037 - (600) 554 -2642 • j ntl lI$1UUl cor? &IY k 1 . POLICY NUMBER: 0039660 -81- 303194 EFFECTIVE: 02/01/11 • ENGLEWOOD CHRISTIAN CHURCH (THE) • 511 N 44TH AVE YAKIMA WA 98908-2698 • j • 03 -203 • YOUR REPRESENTATIVE: JOE DAVIS . SPOKANE VALLEY OFFICE 15407 E MISSION AVE STE 465 SPOKANE VALLEY WA 98037 (800) 554 -2642 • p url utua • SaslUUutl ur►i�r • • PPOUCY NO :: 0038880 -Q2- 303193 ITEM G. PREMIUM: IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF.THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. $9,869.00 DUE AT INCEPTION. PREMIUM SUBJECT TO ADJUSTMENT AT EACH ANNIVERSARY. `° SUMMARY OF ADDITIONAL CHARGES (INCLUDED IN ANNUAL. PREMIUM) TERRORISM - FIRE ONLY: $ 187.00 (STATE REQUIRED) • • • • mis This painllIncludes eopYdQhled meow et march Nutad bwnnene C Church Mupeeti Insurance conensna Comm u �c Includes emelgsne4 mooned M Ina i noe Seninne dt'roe, Ina. veldt lle pemYSelon. Ulu CoPrifpet nue aea 3aMees Moe, Ma 1854 1181 A 001 CD(10.99) - WA PAGE 3 e 2124/1 t 10NPANV ISSUED DATE: 02/24/11 POLICY NO.1, 0039360. 02-303193 COVERAGE: PERSONAL PROPERTY LIMIT OF INSURANCE: $30,000 COINSURANCE PERCENT: 100% COVERED CAUSE OF LOSS: SPECIAL VALUATION: REPLACEMENT COST OPTIONAL COVERAGE AUTOMATIC INCREASE IN INSURANCE ADDITIONAL COVERAGES OR ENDORSEMENTS ADDITIONAL COVERAGE: INSTITUTIONAL INCOME & EXTRA EXPENSE LIMIT OF INSURANCE: $20,000 ANY ONE OCCURRENCE ADDITIONAL COVERAGE: BUILDING ORDINANCE UM IT OF INSURANCE: $200,000 ANY ONE OCCURRENCE • ITEM 2. DEDUCTIBLE - OCCURRENCE: $1000 ITEM 3. ENDORSEMENTS: NONE ITEM 4. MORTGAGEHOLDERS, LOSS PAYEES, AND CONTRACT SELLERS: • NONE • • • A 001 P(10-99 - WA PAGE 2 ISSUED DATE: 02/24/11 • PROPERTY COVERAGE PART DECLARATIONS PAGE i POLICY NO.: 0039680-02405183 ITEM 1. DESCRIPTION OF PREMISES AND COVERAGES: PREMISES NO: 001 BUILDING NO: 001 CONSTRUCTION: FRAME OCCUPANCY: CHURCH AND LESSORS RISK LOCATION: 511 NORTH 44TH AVENUE COUNTY: YAKIMA CITY/STATE: YAKIMA, WA COVERAGE BUILDING LIMIT OF INSURANCE $5,359,000 COINSURANCE PERCENT: 100% COVERED CAUSE OF LOSS: SPECIAL VALUATION: REPLACEMENT COST OPTIONAL COVERAGE: AUTOMATIC INCREASE IN INSURANCE COVERAGE: PERSONAL PROPERTY • LIMIT OF INSURANCE: $955,000 COINSURANCE PERCENT: 100% COVERED CAUSE OF LOSS: SPECIAL VALUATION: REPLACEMENT COST OPTIONAL COVERAGE: AUTOMATIC INCREASE IN INSURANCE PREMISES NO: 001 BUILDING NO: 002 CONSTRUCTION: FRAME OCCUPANCY: STORAGE GARAGE LOCATION: 511 NORTH 44TH AVENUE COUNTY: YAKIMA CITY /STATE: YAKIMA, WA COVERAGE: BUILDING LIMIT OF INSURANCE: $33,000 COINSURANCE PERCENT: 100% COVERED CAUSE OF LOSS: SPECIAL VALUATION: REPLACEMENT COST OPTIONAL COVERAGE: AUTOMATIC INCREASE IN INSURANCE tr • • A 001 P 10-99 - WA PAGE ter�►tr PAGE 1 ISSUED DATE 02/24!11 HIRED AND NONOWNED AUTOMOBILE LIABILITY COVERAGE PART DECLARATIONS PAGE POUCY NO.: 0 039860-02-303193 ITEM 1. COVERAGE DESCRIPTION: COVERAGE UMIT OF INSURANCE • HIRED AND NONOWNED AUTOMOBILE LIABILITY COVERAGE RELIGIOUS INSTITUTIONS - EXCESS INSURANCE EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 3,000,000 ITEM 2. ENDORSEMENITS: MEDICAL EXPENSE COVERAGE - EXCESS INSURANCE ANY ONE PERSON $ 10,000 AGGREGATE $ 25,000 gir • • u ua th urth Husliiel (WARY A 001 H 10-99 - WA PAGE 1 ISSUED DATE: 02/24/11 d • CRIME COVERAGE PART DECLARATIONS PAGE POLICY NO.: 0039860 -02- 303193 ITEM 1. DESCRIPTION OF PREMISES AND COVERAGES; PREMISES NO: 001 BUILDING NO: 001 CONSTRUCTION: FRAME OCCUPANCY: CHURCH AND LESSORS RISK LOCATION: 511 NORTH 44TH AVENUE COUNTY: YAKIMA CITY/STATE: YAKIMA, WA * ** * * * * * * *•*•••a *s.r* ** ** * ** ** *a * ** **••.• * * *** ***** * *** **** ** *gyp** * ******** COVERAGE FORM: CHURCH THEFT OF MONEY AND SECURITIES t ' LIMIT OF INSURANCE: $5,000 DEDUCTIBLE: $250 SPECIAL COVERAGE DAYS: CHRISTMAS, EASTER AND THANKSGIVING ** ** * * * * * * * * *** ** * * * *** * * * ** * * * * **s** * * * ** * * * * ***s *fa ss*** COVERAGE FORM: BLANKET BOND UMIT OF INSURANCE: $15,000 ITEM 2. ENDORSEMENTS: NONE • ur u�ul • t�rerrct c /MYAIV A 001 C(06 -87) - WA PAGE 1 ISSUED DATE: 02/24/11 e _ _ _ __ _ _ _ _ _ _____ _____ __ _ _ _ _ _ _ _ . I. L€_e . 0 � � a , . Ss��6, C! O � TY ED .1 1143 LE E=D 8 PEA Robm 1 6X IT 1111.111111111111111. Exn KITchCti Unkkarrian Universalist Chu[rch of Yakiirna 225 N Second St, Yakima, WA 9 • October 27, 2011 Ken Trainor Sunrise Outreach, LLC 221 East Martin Luther King Blvd. Yakima, WA 98901 Mr. Trainor, I thank you for the opportunity to work with your organization in helping to serve the needs of people in this community. As you know, we at the Unitarian Universalist Church have been asked to host the Emergency Women's Shelter this winter. Our Board of Trustees gave preliminary approval for this project earlier this month, pending the gathering of more information, a financial analysis, and completion of our downstairs restroom renovation project. These items are proceeding, and we have scheduled a congregational forum for this Sunday, October 30, and have final approval for the project on the agenda for our next Board 41 meeting on Nov. 3` 1 anticipate we'll have final approval at this time. In the meantime, we are proceeding with plans to prepare our facility host this shelter this winter. Thank you again for the opportunity to serve together. In faith, /I , Rev. Ken Jones Minister cc: Susan Kaphammer, President UUCY Board of Trustees Mutual Company Nonassessable CHURCH MUTUAL INSURANCE COMPANY 3000 Schuster Lane, P.O. Box 357, Merrill, WI 54452 COMMON POLICY DECLARATIONS PAGE POLICY NO.: 0233326 -02 - 348823 ITEM 1. NAMED INSURED AND ADDRESS: UNITARIAN UNIVERSALIST CHURCH OF YAKIMA 225N2NDST YAKIMA WA 98901 -2332 ITEM 2. POLICY PERIOD: FROM 06/20/11 TO 06/20/14 0233326 -02 - 218565 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE (RENEWAL OF) ITEM 3. THE NAMED INSURED IS: RELIGIOUS INSTITUTION ITEM 4. AGENT: 03 -203 JOE DAVIS ROCKY MOUNTAIN WEST DIVISION 3000 SCHUSTER LANE MERRILL WI 54452 (800) 554 -2642 ITEM 5. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS: PROPERTY COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: A 100(01 -01) PROPERTY CONDITIONS I A 1001(01 -08) IDENTITY RECOVERY COVERAGE FORM A 1009.1WA(07 -09) WATER EXCLUSION ENDORSEMENT A 101(04-06) BUILDING AND PERSONAL PROPERTY COVERAGE - RELIGIOUS A 101.1 WA(02 -05) OPTIONAL COVERAGES - AUTOMATIC INCREASE IN INSURANCE A 117.1(05 -89) COVERAGE EXTENSIONS AND ADDITIONAL COVERAGES A 127(04 -06) CAUSES OF LOSS - SPECIAL FORM A 154(10 -99) SYSTEMS /EQUIPMENT BREAKDOWN COVERAGE FORM A 177(04 -06) WASHINGTON CHANGES A 177.1(04 -06) WASHINGTON CHANGES - EXCLUDED CAUSES OF LOSS A 945.2(01 -08) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM GENERAL LIABILITY COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: A 052(06 -87) NUCLEAR ENERGY LIABILITY EXCLUSION - BROAD FORM A 200(01 -04) GENERAL LIABILITY COVERAGE PART - OCCURRENCE BASIS A 200.1(12 -06) AMENDATORY ENDORSEMENT - PERSONAL INJURY A 200.2(12 -07) BODILY INJURY DEFINITION A 2012(12 -07) CORPORATE ENTITY ENDORSEMENT A 2013(12 -07) MEDICAL EXPENSE AMENDMENT A 202(01 -04) GENERAL LIABILITY ADDITIONAL PROVISIONS - RELIGIOUS A 205(06 -87) LOSS OF LIFE A 229.1(05 -89) EXCLUSION - MEDICAL EXPENSE COVERAGE - SPECIFIC ACTIVITY OR EVENT A 249 WA(08 -04) STOP GAP - EMPLOYERS LIABILITY COVERAGE ENDORSEMENT A 251(09 -94) EXCLUSION LEAD LIABILITY Church Mutual 1110 ULStlNAN[E CONPlli A 001 CD(10 -99) - WA PAGE 1 ISSUED DATE: 06/15/11 POLICY NO.: 0233326 -02- 348823 GENERAL LIABILITY COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: A 253(12 -07) LEGAL DEFENSE COVERAGE FORM A 254(05 -08) AMEND OF INSURING AGREEMENT - KNOWN INJURY OR DAMAGE • A 255(01 -04) CATASTROPHIC VIOLENCE RESPONSE COVERAGE A 262(01 -04) SEXUAL MISCONDUCT OR SEXUAL MOLESTATION LIAB AND MED A 268(05 -03) WAR LIABILITY EXCLUSION A 9006(01 -08) EXCL OF PUN DAMAGES RELATED TO A CERT ACT OF TERROR A 937.1(04 -06) WASHINGTON CHANGES A 945.3(01 -08) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CRIME COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: A 300(06 -87) CRIME CONDITIONS FORM A 302(05 -89) CHURCH THEFT OF MONEY AND SECURITIES COVERAGE FORM A 309(06 -87) BLANKET BOND COVERAGE FORM A 358(06 -03) WASHINGTON CHANGES PROFESSIONAL LIABILITY COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: A 500(01 -04) COUNSELING PROFESSIONAL LIABILITY COVERAGE - OCCURRENCE A 505(12 -04) DIRECTORS, OFFICERS & TRUSTEES LIAB - CLAIMS MADE A505.1(12 -07) SPOUSAL LIABILITY A 520(01 -04) EMPLOYMENT PRACTICES LIABILITY COVERAGE A 529(12 -04) EMPLOYMENT PRACTICES LIABILITY COVERAGE AMENDMENT A 530(12 -06) AFFILIATED ENTITY DISPUTE LEGAL DEFENSE COVERAGE A 534(12 -07) CORPORATE ENTITY ENDORSEMENT A 535(12 -07) CORPORATE ENTITY ENDORSEMENT DO &T LIABILITY A 9006(01 -08) EXCL OF PUN DAMAGES RELATED TO A CERT ACT OF TERROR A 937.1(04 -06) WASHINGTON CHANGES A 945.3(01 -08) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM HIRED AND NONOWNED AUTOMOBILE LIABILITY COVERAGE PART AND ITS FORMS AND ENDORSEMENTS: A 600(01 -04) HIRED AND NONOWNED AUTO LIAB - RELIGIOUS INSTITUTION A 602(06 -00) MEDICAL EXPENSE COVERAGE A 602.1(12 -07) MEDICAL EXPENSE AMENDMENT A 605 WA(12 -06) RENTAL AUTOMOBILE CONTRACTUAL LIABILITY ENDORSEMENT A 606(12 -07) CORPORATE ENTITY ENDORSEMENT A 692(04 -93) WASHINGTON CHANGES - RENEWAL AUTOMOBILE ENDORSEMENT A 9006(01 -08) EXCL OF PUN DAMAGES RELATED TO A CERT ACT OF TERROR A 945.3(01 -08) CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM FORMS AND ENDORSEMENTS WHICH APPLY TO THIS ENTIRE POLICY: A 050(01 -98) MUTUAL AND COMMON POLICY CONDITIONS A 051(06 -87) CALCULATION OF PREMIUM A 937(05 -96) WASHINGTON CHANGES UN 720(01 -08) NOTICE - DISCLOSURE OF TERRORISM PREMIUM A 001 CD(10 -99) - WA PAGE 2 ISSUED DATE: 06/15/11 • • GENERAL LIABILITY COVERAGE PART DECLARATIONS PAGE POLICY NO.: 0233326 -02- 348823 ITEM 1. LIMITS OF INSURANCE: GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS - COMPLETED $ 3,000,000 OPERATIONS AND SEXUAL MISCONDUCT OR SEXUAL MOLESTATION) PRODUCTS- COMPLETED OPERATIONS AGGREGATE LIMIT $ 1,000,000 EACH OCCURRENCE LIMIT (BODILY INJURY AND PROPERTY DAMAGE $ 1,000,000 COMBINED) PERSONAL AND ADVERTISING INJURY LIMIT (COMBINED) $ 1,000,000 MEDICAL EXPENSE LIMIT -ANY ONE PERSON (OTHER THAN SEXUAL MISCONDUCT OR SEXUAL MOLESTATION) $ 15,000 PROPERTY DAMAGE LEGAL LIABILITY - ANY ONE OCCURRENCE $ 300,000 SEXUAL MISCONDUCT OR SEXUAL MOLESTATION LIMIT (COMBINED) - ALL LOCATIONS AND OPERATIONS EACH CLAIM LIMIT $ 300,000 AGGREGATE LIMIT $ 300,000 SEXUAL MISCONDUCT OR SEXUAL MOLESTATION MEDICAL EXPENSE LIMIT ANY ONE PERSON $ 10,000 AGGREGATE LIMIT $ 50,000 LEGAL DEFENSE COVERAGE LIMIT EACH DEFENSIBLE INCIDENT LIMIT $ 5,000 AGGREGATE LIMIT $ 15,000 CATASTROPHIC VIOLENCE RESPONSE PER PERSON LIMIT $ 50,000 EACH VIOLENT INCIDENT LIMIT $ 300,000 VIOLENT INCIDENT AGGREGATE LIMIT $ 300,000 EMPLOYERS LIABILITY (STOP GAP) COVERAGE BODILY INJURY BY ACCIDENT -EACH ACCIDENT $ 1,000,000 BODILY INJURY BY DISEASE -EACH EMPLOYEE $ 1,000,000 BODILY INJURY BY DISEASE -- AGGREGATE LIMIT $ 1,000,000 ITEM 2. DESCRIPTION AND CLASSIFICATION OF PREMISES AND OPERATIONS: ALL PREMISES AND OPERATIONS UNLESS EXCLUDED IN ITEM 3 BELOW. NONE ITEM 3. EXCLUSION ENDORSEMENTS: Church Mutual • INSflANCE LOMPAR A 001 G(03 -04) - WA PAGE 1 ISSUED DATE: 06/15/11 POLICY NO.: 0233326 -02- 348823 EXCLUSION - MEDICAL EXPENSE - SPECIFIC ACTIVITY OR EVENT: • BUDDHIST CONGREGATION ' METROPOLITAN CHURCH LEAGUE OF WOMEN VOTERS OTHER ENDORSEMENTS: LOSS OF LIFE ENDORSEMENT. EACH PERSON LIMIT OF INSURANCE: $ 15,000 EACH ACCIDENT LIMIT OF INSURANCE: $ 20,000 A 001 G(03 -04) - WA PAGE 2 ISSUED DATE: 06/15/11 CRIME COVERAGE PART DECLARATIONS PAGE POLICY NO.: 0233326 -02- 348823 • ITEM 1. DESCRIPTION OF PREMISES AND COVERAGES: PREMISES NO: 001 BUILDING NO: 001 CONSTRUCTION: JOISTED MASONRY OCCUPANCY: CHURCH AND LESSORS RISK LOCATION: 225 N 2ND ST COUNTY: YAKIMA CITY /STATE: YAKIMA, WA COVERAGE FORM: CHURCH THEFT OF MONEY AND SECURITIES LIMIT OF INSURANCE: $1,000 DEDUCTIBLE: $100 SPECIAL COVERAGE DAYS: CHRISTMAS, EASTER AND THANKSGIVING COVERAGE FORM: BLANKET BOND LIMIT OF INSURANCE: $25;000 DEDUCTIBLE: FULL COVERAGE ITEM 2. ENDORSEMENTS: NONE Church A 001 C(06 -87) - WA PAGE 1 INSURANCE (ONPANI ISSUED DATE: 06/15/11 1 l v Z-.) J"t• U rt Vilat(lan Ckwt s la V\ Ciil vvGG) - • Hoar ?tan • i ;� � jY�. ••mac I i,^ i 1 1 .1 i f� I 1 L [= 0 EJ � •,0.,,_. I .=..... /\s { J J 1 �(,.tc� T _III •