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Puget Sound Schools <br />12 <br />Effective 09/01/93 to Expiration 08/31/94 <br />MEMBER DISTRICT: <br />South Central School District <br />4640 S 144th St <br />Tukwila, WA 98168 <br />TYPE OF COVERAGE: <br />GENERAL AND AUTOMOBILE LIABILITY <br />by <br />ce5let <br />Xf s <br />rr <br />APPLICABLE DATES: 05/21/94 TO 05/21/94 <br />LIMITS: <br />CERTIFICATE OF COVERAGE <br />CERTIFICATE NUMBER 8 -0383 <br />THIS CERTIFICATE DOES AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PUGET SOUND SCHOOLS <br />RISK MANAGEMENT POOL (PSSRMP) COVERAGE AGREEMENT SUBJECT TO ALL TERMS, EXCLUSIONS AND <br />CONDITIONS OF THE SELF INSURANCE AGREEMENT IN FULL FORCE AND EFFECT DURING THE FOLLOWING TERM: <br />CERTIFICATE HOLDER: <br />City of Tukwila <br />6200 S Center Blvd <br />Tukwila, WA 98188 <br />Combined Single Limit <br />$1,000,000 00 per Occurrence <br />PROPERTY DEDUCTIBLE: not applicable <br />DESCRIPTION: <br />South Central School District's use of facilities for BBQ and picnic <br />ADDITIONAL INSURED ENDORSEMENT <br />The City of Tukwila, its Department of Parks and Recreation, and their <br />employees and agents are named additional insureds but only as respects the <br />district's negligent acts, and except for the sole negligence of the City of <br />Tukwila <br />THE ADDITION OF MORE THAN ONE INSURED DOES NOT SERVE TO INCREASE THE LIMITS OF LIABILITY <br />Authorized Signature Date of Issue <br />SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE CANCELLED OR CHANGED AS TO MATERIALLY AFFECT <br />COVERAGE EVIDENCED BY THIS CERTIFICATE, BEFORE THE EXPIRATION DATE THEREOF PSSRMP WILL <br />ENDEAVOR TO PROVIDE THIRTY (30) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT FAILURE TO <br />MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PSSMRP ITS <br />AGENTS OR REPRESENTATIVES. <br />If you have any questions regarding this certificate, call the Pool office <br />at 206/439 -6950 <br />17H) JC 4(111 I i `I Burn: A00 10 n( J (20f) 429 095U 1 400 444 7569 <br />