Catholic Community Services 3/3/2020

A►c DD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/9/2019 THIS 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 policy(ies)must have ADDITIONAL INSURED provisions or 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 NAME: Stephen Erni Arthur J.Gallagher Risk Management Services, Inc. PHONE FAX No.Ext):425-454-3386 FAC,No):425-451-3716 777 108th Ave NE,#200 E-MAIL Bellevue WA 98004 ADDRESS: Stephen Erni@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Underwriters at Lloyd's London 15792 INSURED CORPOFT-01 INSURER B:Old Republic Union Insurance Company 31143 Corporation of the Catholic Archbishop of Seattle Catholic Community Services of Western Washington INSURER C State National Insurance Company,Inc 12831 1918 Everett Ave INSURER D: Everett WA 98201 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:624892477 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY BP1023019 7/1/2019 7/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RETED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $NII PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $1,000,000 PRO X POLICY JECT LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER $ A AUTOMOBILE LIABILITY BP1023019 7/1/2019 7/1/2020 COMacciBINdEent)D SINGLE LIMIT $1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) B UMBRELLA LIAB X OCCUR 821900 0785428 7/1/2019 7/1/2020 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION NDE-0937646-19 7/1/2019 7/1/2020 X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E L EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Limits shown are inclusive of defense and insured retention.Coverage for Additional Insureds is restricted to the amount of insurance required by contract or permit.Retention under policy#BP1023019(A XV,Non-Admitted)is$250,000 for Liability.The applicable location maintenance deductible that applies to this Certificate is$0 for Liability. Coverage only extends for claims directly arising out of the operations of the Volunteer Chore Services Program,and Family and Children Services for the term of the certificate. Includes Counseling Errors&Omissions Coverage. 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 Everett, Its Officers Employees and Agents 2930 Wetmore Avenue AUTHORIZED REPRESENTATIVE Everett WA 98201 69 ,cam. �c ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD