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.--'"""N WORKOPP-01 TBREWSTER
<br /> A REY CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> U8t2424
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
<br /> PRODUCER ,NAME•
<br /> PLC Insurance LLC PHONE FAX —
<br /> 19401 40th Ave W,Suite 440 /C,No,Eat):(A (425)712-3664 i cnic,No):(425)712-3786
<br /> Lynnwood,WA 98036 !fakss_pIc@plcins.com —._
<br /> __ _ INSURERS)AFFORDING COVERAGE NAIC f
<br /> ___ _ _., _ INSURER A:Be_rkshire Hathaway Spec Ins Co
<br /> INSURED INSURER S:
<br /> --
<br /> Work Opportunities,Inc, INSURER C__
<br /> 6515-202nd St.SW INSURER D:
<br /> Lynnwood,WA 98036-5998 I _ -
<br /> 4 INSURERE: _ _ _. _._____
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL;SUBRj POLICY NUMBER I POLICY EFF ' POLICY EXP
<br /> LTR INS°,WVD t IMM/DDlYYYY.ti eamtDDI Y , LIMITS
<br /> A X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE i$ 1,000,000
<br /> CLAIMS-MADE [X l OCCUR 47SPK14849805 1/1/2020 1/1/2021 DAMAGEES NTEDn t $ 100,000
<br /> _. ,MED EXP lAcy one persce) $ 5,000
<br /> _. I PERSONAL&ADV INJURY I$ 1,000,000
<br /> I GEN'L AGGREGATE p�LIMIT�APPLIES PER l 1 GENERAL AGGREGATE -f$ 3,000,000
<br /> X,POLICY JECT I I LOC PRODUCTS-COMP/OP AGG $ 3,000,000
<br /> I OTHER WA STOP GAP s 1,000,000
<br /> A AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT 1,000,000
<br /> I LFaacden:r $
<br /> X I ANY AUTO I 47RWS14849905 1/1/2020 ! 1/1/2021 I BODILY INJURY person)_ $
<br /> OWNED ,SCHEDULED — `—
<br /> ( i AUTOS ONLY iv AUTOS BODILY INJURY(Per aodd I $
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> __ AUTOS ONLY I___AUTOS ONLY !(Per accidents $
<br /> UMBRELLA LIAB I I OCCUR EACH OCCURRENCE i$
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE —I$
<br /> DED 'RETENTION$
<br /> WORKERS OYERS COMPENSATION
<br /> YIN E _$STATUTE. ,ERH
<br /> ANY PROPRIETORJPARTNER/EXECUTWE f I E.L EACH ACCIDENT
<br /> FICERIIM In NH)EXCLUDED? I NIA -
<br /> Ifyes,describe under El.DISEASE-EA EMPLOYE1 1
<br /> DESCRIPTION OF OPERATIONS below . E.L.DISEASE-POLICY LIMIT,$
<br /> 1
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> RE:Grant Funding
<br /> City of Everett,its officers,employees and agents are included as an additional insured as required by written contract per attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 2930 Wetmore Avenue Ste.8A
<br /> Everett,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> Or PRp `r
<br /> ACORD 25(2016/03) it 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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