Domestic Violence Services of Snohomish Co 1/27/2022 Amendment 5

AC Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/8/2021 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 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 Debbie Cook NAME: Leavitt Group Northwest 04x. Ext): (600)726-8771 FAX oic,No) (e66)729-9160 PO Box 65770 EMAIL debbie-cook@leavitt.com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC 0 University Place WA 98464 iNsuRERA:Great American Insurance Company C16691 INSURED INSURER B: \ Domestic Violence Services of Snohomish County INSURERC: PO Box 7 INSURER D INSURER E: Everett WA 98206-0007 INSURERF: COVERAGES CERTIFICATE NUMBER:21-22 Master REVISION NUMBER: THIS IS TO CERTIFYTHATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXP W YYY UM1T5 LTR INSD VO POLICY NUMBER IMMIDDIY) IMMMDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A ENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1f/0,000 X PAc059525508 10/10/2021 10/10/2022 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 X POLICY JEC7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 Abuse&Molestation Aggregate S 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ 1,000,000 (Ea accidenent) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED CAP59525608 10/10/2021 10/10/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S _ HIRED AUTOS _AUTOS (Per accident) S X UMBRELLALWB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE S 2,000,000 DED X RETENTIONS 10,000 UMB59525708 10/10/2021 10/10/2022 WORKERS COMPENSATION PER X OTH- AND EMPLOYERS'UABILITY Yf N STATUTE ER ANY PROPRI ETOR/PARTN ER/EXECUTNE N/A WA Stop Gap E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBEREXCLUDED? PAC059525508 10/10/2021 10/10/2022 A (Mandatory In NH)NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT $ 1,000,000 A Employee Theft PAC059525508 10/10/2021 10/10/2022 Aggregate Urnit 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) The City of Everett, Its officers, employees and agents are named as an additional insured as per terms and conditions of form CG2026 04 13 attached. CERTIFICATE HOLDER CANCELLATION ELandry@everettwa.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 2930 Wetmore Ave. Ste. #SA ACCORDANCE WITH THE POLICY PROVISIONS. Everett, WA 98201 AUTHORIZED REPRESENTATIVE Jeff Olsen/DECOOK 4 O @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)