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� l ® DATE(MMIDDIYYYY)
<br /> ACCORD CERTIFICATE OF LIABILITY INSURANCE
<br /> 1/29/2021
<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 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 CONTACT
<br /> NAME: Stephen Erni
<br /> Arthur J. Gallagher Risk Management Services, Inc. P HO No.Extl:425-586-1002 (a,No):425-451-3716
<br /> P.O. Box 367 E-MAIL
<br /> Bellevue WA 98009-0367 ADDRESS: Stephen_Erni©ajg.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Berkley National Insurance Company 38911
<br /> INSURED VOLUOFA-11 INSURER B:
<br /> Volunteers of America Western Washington
<br /> P.O. Box 839 INSURER C:
<br /> 2802 Broadway INSURER D:
<br /> Everett WA 98206-0839 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1308301825 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 LIMITS
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY Y HHS 8528008-10 6/30/2020 6/30/2021 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000
<br /> X Prof.Liability MED EXP(Any one person) $20,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY PRO-
<br /> JECT X LOC PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY HHS 8528008-10 6/30/2020 6/30/2021 COMBINED SINGLE LIMIT $1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED (Perry acciROPERTY dent)
<br /> $
<br /> AUTOS ONLY AUTOS ONLY
<br /> A X UMBRELLA LIAB X OCCUR HXL 8584284-10 6/30/2020 6/30/2021 EACH OCCURRENCE $1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000
<br /> DED X RETENTION$1n Jul() $
<br /> A WORKERS COMPENSATION HHS 8528008-10 6/30/2020 6/30/2021 PER STATUTE X OT ERH WA Stop Gap
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBEREXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:Community Development Block Grant(CDBG)Subrecipient Agreement
<br /> City of Everett,its officers,employees and agents are included as Additional Insured as respects General Liability policy,pursuant to and subject to the policy's
<br /> terms,definitions,conditions and exclusions.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Everett Department of Community, ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Planning, and Economic Development
<br /> 2930 Wetmore Ave., Suite 8A AUTHORIZED REPRESENTATIVE
<br /> Everett WA 98201 /,LJ.A...(
<br /> 1
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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