Memorial Lutheran Church

Office: 2602 E. 28th St., Vancouver WA 98661

360-695-7501 (M-F, 9-1) Email: office@mlc.org

CERTIFICATE OF LIABILITY INSURANCE:

(CRITERIA ESTABLISHED AT THE DIRECTION OF MEMORIAL LUTHERAN CHURCH BOARD OF DIRECTORS)

Certificate of Liability Insurance and Commercial General Liability Broadening Endorsement Criteria:

“Additional Insured” as stated in the Certificate of Liability Insurance, Important”  and Commercial General Liability Broadening Endorsement, provision one (1) requires a written contract or written agreement between the insured and the certificate holder with regard to facilities and properties of Memorial Lutheran Church, 2602 E 28st Vancouver, WA, 98661.

“Certificate of Liability Insurance”

Name and address of Insurance Company:

Name and address of Insured:

Effective Date:

Expiration Date:

Policy Number:

  1. Type of Insurance: Commercial General Liability
  1. Commercial General Liability: “OCCUR”
  2. Gen’l Aggregate Limit Applies Per: “LOC”
  3. “Additional Insured:”
  4. Amount of Insured:
  1. Each Occurrence =$1,000,000
  2. Damage to Rented Premises (Each Occurrence) = $1,000,000
  3. Medical Expenses= $10.000
  4. Personal & ADV Injury=$1,000,000
  5. General Aggregate= $2,000,000
  1. Description:
  1. All activities of ______________ (Name of Group)
  2. Only with regard to the facilities or properties of Memorial Lutheran Church, 2602 E 28th St, Vancouver WA. 98661
  3. Note: Place no limitations on: activities, date, time, etc.
  4. Required:
  1. Certificate Holder:

                Memorial Lutheran Church, 2602 E 28st Vancouver, WA, 98661

  1. Additional Insured:

                Memorial Lutheran Church, 2602 E 28st Vancouver, WA, 98661

  1. Instructions: Submit to the Landlord the Certificate of Liability Insurance and Commercial General Liability Broadening Endorsement, all endorsements and supporting policy provisions to Memorial Lutheran Church, 2602 E. 28th St., Vancouver WA 98661.
  2. Termination of Use: Failure by the Tenant to maintain continuity of Certificate of Liability Insurance and Commercial General Liability Broadening Endorsement coverage will result in termination of the rental agreement.