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DATE(MMlDD/YYYY)
<br /> AC to URD CERTIFICATE OF LIABILITY INSURANCE
<br /> `.--�. 6/25/2021
<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 Ileu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Stephen Erni
<br /> Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX
<br /> pc,No)z425-451-3716
<br /> 777 108th Ave NE,#200 (ANC.No,Ext):425-586-1002
<br /> Bellevue WA 98004 E-MAIL
<br /> Stephen_Erni@ajg.cam
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Great American Insurance Company 16691
<br /> INSURED VOLUOFA•11 INSURER B:Great American Alliance Insurance Company 26832
<br /> Volunteers of America Western Washington
<br /> P.O. Box 839 INSURER C:
<br /> 2802 Broadway INSURER D: w _•
<br /> Everett WA 98206-0839 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:606464899 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 /> IN
<br /> R �^ TA DISCS- EF� "� " �` POLICY F POLIO'EXP y 4
<br /> R
<br /> TYPE OF INSURANCE I INSD WVp POLICY NUMBER (MMIDD/YYYY) (MM(DD/YYYY) LINTS
<br /> A X I COMMERCIAL GENERAL LIABILITY Y PAC396479800 6/30/2021 6/30/2022 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE l X I 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 f
<br /> POLICY PRO- 571
<br /> I X
<br /> JECT LOG PRODUCTS COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILEUABILITY CAP396479900 6/30/2021 6/30/2022 COMBINED SINGLE LIMIT
<br /> .LEa accident) $1,000,000
<br /> _ '..a_.._.. _ ..
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY _ AUTOS
<br /> HIREDNON-OWNED PROPERTY DAMAGE $
<br /> X y Per accident _
<br /> AUTOS ONLY AUTOS ONLY -( .-�- --�---- -- . ---------
<br /> B X UMBRELLA LIAB X OCCUR UMB396480000 6/30/2021 6/30/2022 EACH OCCURRENCE $5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 ......
<br /> DED I I RETENTION$ ,$
<br /> A WORKERS COMPENSATION PAC396479800 6/30/2021 6/30/2022 I STATUTE X I ERH WA Stop Gap
<br /> AND EMPLOYERS'LIABILITY
<br /> AN YPROPRIETOR/PARTNER/EXECUTIVE Y/N N l A E.L.EACH ACCIDENT_ $1,000,000
<br /> OFFICERJMEMBER EXCLUDED?
<br /> (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $1,000,000
<br /> II 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 it more space is required)
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Dept. of Planning&Community Development
<br /> 2930 Wetmore Ave., Suite 8A AUTHORIZED REPRESENTATIVE
<br /> Everett WA 98201
<br /> USA 6Y1A-1-4-4'et
<br /> I
<br /> 1988.2015 ACORD CORPORATION. All rights resented.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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