Volunteers of America of Western Washington 8/10/2021

A`ORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/6M/DD/ 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 425-586-1002 777 108th Ave NE,#200 (A/C,No,Ext): (A/C,No):425-451-3716 Bellevue WA 98004 ADDRESS: Stephen Erni@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Great American Insurance Company 16691 INSURED VOLUOFA-11 INSURER B:Great American Alliance Insurance Company 26832 Volunteers of America Western Washington P.O. Box 839 INSURER C: 2802 Broadway INSURER D: Everett WA 98206-0839 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1476253423 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. IN ADDL TR INSD SWVD POLICY NUMBER /YUBR POLICY EFF POLICY EXP L TYPE OF INSURANCE (MM/DD/YYYY),(MM/DDYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y PAC396479800 6/30/2021 6/30/2022 EACH OCCURRENCE $1,000,000 DAMAGE D CLAIMS-MADE X OCCUR PREMISESO(EaENTE occu occurrence) $1,000,000 X Prof.Liability MED EXP(Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT X LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y CAP396479900 6/30/2021 6/30/2022 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) 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 X UMBRELLA LIAB X OCCUR UMB396480000 6/30/2021 6/30/2022 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION PAC396479800 6/30/2021 6/30/2022 PER X ERH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER WA Stop Gap ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? 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) City of Everett,its officers,employees,and agents are included as Additional Insured as respects General Liability and Business Auto Liability as respects Agreement for Management Services between City of Everett and Volunteers of America for the Carl Gipson Senior Center.Coverage is Primary and Non-Contributory. 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 AUTHORIZED REPRESENTATIVE 6/12"Af4-- t ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD