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<br /> Ac Ra' EP CEI FICATE OF LIABILITY INSU .NCE DATE(MMrDp YYYY)
<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 lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> Arthur J. Gallagher RiskManagement Services, Inc. PHONE Stephen Erni FAX
<br /> 777 108th Ave NE, #200 rac.No.Ext):425-586-1002 (A/C,No):425-451-3716
<br /> E-MAIL
<br /> Bellevue WA 98004 ADDRESs: Stephen_Emi@ajg com
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<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 0:
<br /> 2802 Broadway INSURER D:
<br /> Everett WA 98206-0839
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:790836272 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;SUBRi POLICY EFF POLICY EXP
<br /> LTR T._ TYPE OF INSURANCE '(MM/DDIYYYY) _(MMIDDIYYYY)i INSD WVD i POLICY NUMBER LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y PAC396479800 6/30/2021 , 6/30/2022 i EACH OCCURRENCE $1,000,000
<br /> LDAMAGE TO RENTS
<br /> CLAIMS-MADE X i OCCUR PREMISES Ea occurrence $1 000,000
<br /> X Prof.Liability ! I MED EXP(Any one person) $20,000
<br /> _ E I PERSONAL&ADV INJURY $1,000,000
<br /> GE AGGREGATE LIMIT APPLIES PER: : GENERAL AGGREGATE $2,000,000
<br /> POLICY; JEC I X i LOC PRODUCTS-COMP/OP AGO $2,000,000
<br /> OTHER: ` $
<br /> A AUTOMOBILE LIABILITY CAP396479900 6/30/2021 6/30/2022 COMBINED SINGLE LIMIT
<br /> (Ea acc dent $1,000,000
<br /> ___
<br /> X I ANY AUTO BODILY INJURY(Per person) $
<br /> I OWNED -' SCHEDULED BODILY INJURY(Per accident) $
<br /> I AUTOS ONLY ^ AUTOS
<br /> HIRED X NON-OWNED I !PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident,), __ „, _
<br /> $_
<br /> B X UMBRELLA LIAB OCCUR UMB396480000 6/30/2021 6/30/2022 EACH OCCURRENCE $5.000,000
<br /> EXCESS LIAB CLAIMS-MADE , AGGREGATE $5.000,000
<br /> DEC RETENTION$ 1 $
<br /> A WORKERS COMPENSATION PAC396479800 6/30/2021 6/30/2022 : PER ix I OTH-
<br /> AND EMPLOYERS'LIABILITY Y!N , STATUTE 1 ER WA Stop Gep_,__,-_
<br /> ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICERIMEMBEREXCLUDED? !N!A
<br /> I(Mandatory In NH) I E.L.DISEASE-EA EMPLOYEE $1 000,000
<br /> If yes,describe under —
<br /> DESCRIPTION OF OPERATIONS below I l E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> i
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS r 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
<br /> Everett WA 98201 AUTHORIZED REPRESENTATIVE
<br /> USA
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> 2"of14 686
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