Catholic Community Services 6/12/2020

ACCPREP DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 777 108th Ave NE,#200 (A/C,No,Eat):425-454-3386 (A/C,No):425-451-3716 Bellevue WA 98004 ADDRESS: Stephen_Erni@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Underwriters at Lloyd's London 15792 INSURED CORPOFT-01 INSURERB:Old Republic Union Insurance Company 31143 Corporation of the Catholic Archbishop of Seattle — — — Catholic Community Services of Western Washington NSURERC:State National Insurance Comp.. , Inc 12831 1918 Everett Ave INSURER D: Everett WA 98201 INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER:588028853 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. ILTR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY i BP1023019 7/1/2019 7/1/2020 EACH OCCURRENCE _ $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $Nil Ili i PERSONAL&ADV INJURY $1,000,000 GENII AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $1,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGO $1,000,000 OTHER $ A AUTOMOBILE LIABILITY BP1023019 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED I SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS v HIRED X NON-OWNED I PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ B UMBRELLA LIAB X I $ 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 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A - —(Mandatory in NH) I 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 contract between The City of Everett and Catholic Community Services Foster Care Program,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 Everett WA 98201 AUTHORIZED REPRESENTATIVE 7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD