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A g CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/rYYY)
<br /> l0/9/2020
<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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CON(ALT Debbie Cook
<br /> NAME:
<br /> Leavitt Group Northwest PHONE ( )726-8771 FAX
<br /> 800 (866)728-9168
<br /> (A/C.No,Ext): (A/C,No):
<br /> PO Box 65770 ADDRESS:debbie-cook@leavitt.com
<br /> INSURERS)AFFORDING COVERAGE NAIL S
<br /> University Place WA 98464 INSURERA:Great American Insurance Company C16691
<br /> INSURED INSURER B:
<br /> Domestic Violence Services of Snohomish County INSURER C:
<br /> PO Box 7 INSURER D:
<br /> INSURER E:
<br /> Everett WA 98206-0007 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:20-21 Master 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 ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD,WVD POLICY NUMBER
<br /> (MMND/YYYI) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000
<br /> PREMISES(Ea occurrence) S
<br /> X PAC059525507 10/10/2020 10/10/2021 MED EXP(My one person) $ 5,000
<br /> PERSONAL sADVINJURY $ 1,000,000
<br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000
<br /> PRO-
<br /> X POLICY JECT LOC
<br /> PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: Abuses Molestation Aggregate $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ 1,000,000
<br /> (Ea accident)
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED - SCHEDULED AUTOS AUTOS
<br /> CAP59525607 10/10/2020 10/10/2021 BODILY INJURY(Per accident) $
<br /> _
<br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE
<br /> AUTOS (Per accident) $
<br /> Underinsured motorist combined sir $ 1,000,000
<br /> X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> A EXCESS LIAB CLAIMS-MADE
<br /> AGGREGATE $ 2,000,000
<br /> DED X Rt IENTION$ 10,000 0M359525707 10/10/2020 10/10/2021 $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS LIABILITY Y/N STATUTE X ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N I A A
<br /> (Mandatory in NH) PAC059525507 10/10/2020 10/10/2021 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below HA Stop Gap EL DISEASE-POUCY UMIT $ 1,000,000
<br /> A Employee Theft PAC059525507 10/10/2020 10/10/2021 Aggragate Limd $100,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom space is required)
<br /> The City of Everett, Its officers, employees and agents are named as an additional insured as per terms
<br /> and conditions of form CG2026 04 13 attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> KLandry@everettwa.gov
<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 /> 2930 Wetmore Ave. Ste. #8A ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett, WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> IJeff Olsen/TRFUQI) 'i 2& _
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(201401)
<br />
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