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<br /> Client#: 326528 BOYSGIR1
<br /> ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)08/23/2016
<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 be endorsed.If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Please send all requests by _
<br /> USI Kibble&Prentice PHONEfax or email FAX 610-362-8518
<br /> (ac,No,Ext): (ac,No):
<br /> 601 Union Street, Suite 1000 ADDRESS: CLCertRequest©usi.com
<br /> Seattle,WA 98101 INSURERS)AFFORDING COVERAGE NAIC N
<br /> 206-441-6300 INSURER A:Great American Alliance Ins Co 26832
<br /> INSURED INSURERS:Berkley Regional Insurance Co 29580
<br /> Boys&Girls Clubs of Snohomish County
<br /> INSURER C:
<br /> 9502 19th Ave SE,Ste F
<br /> INSURER D:
<br /> Everett,WA 98208
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: K2 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTRINSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY PAC052125703 07/06/2016 07/06/2017 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR PREMISES(EaE urrrence) $300,000
<br /> X WA Stop Gap/EL MED EXP(Any one person) $15,000
<br /> PERSONALS ADV INJURY $1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY JECT I X I LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: WA Stop Gap $1,000,000
<br /> A AUTOMOBILE LIABILITY CAP052125803 07/06/2016 07/06/2017 (Ea as rri SINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS _ AUTOS $ _
<br /> X HIRED AUTOS X AUT SWNED PROPERTY(Per acddentDAMAGE
<br /> A X UMBRELLA LIABX OCCUR UMB052125903 07/06/2016 07/06/2017 EACH OCCURRENCE $10,000,000
<br /> EXCESS LIAB CLAIMS-MADE XS of GL,Auto& AGGREGATE $10,000,000
<br /> DED X RETENTION$10,000 Employers Liab. $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILRY Y/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B CRIME/FIDELITY BCCR4500149321 07/06/2016 07/06/2017 $400,000 Employee Theft
<br /> $2,500 Deductible
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Any and all grants.The City of Everett, its officers,employees and agents are Additional Insured as
<br /> respects General Liability per attached endorsement CG2026 07/04.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Dept of Planning&Community Development ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 2930 Wetmore,Suite 8A
<br /> Everett,WA 98201 AUTHORIZED. , REPRESENTATIVE''{
<br /> ed,Z1-n..-) 2`.4 l-lei "V
<br /> ©1988-2014 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S18465800/M18063802 CNMJU
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