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DATE(MM/DD/YYYY) <br /> A�® CERTIFICATE OF LIABILITY INSURANCE <br /> 8/11/2016 <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 NAMEACT Stephen Erni <br /> Arthur J. Gallagher Risk Management Services, Inc. PHONE 425-454-3386 I FAX 425-451-3716 <br /> 777 108th Ave NE,#200 (A/C.No Fat) (A/C,No): <br /> E-MAIL <br /> si_Stephen_Erni@ajg_com <br /> Bellevue WA 98004 E-MAIL <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Underwriters at Lloyd's London 15792 <br /> INSURED CORPOFT-01 INSURER B:Old Republic Union Insurance Compan - 31143 <br /> Corporation of the Catholic Archbishop of Seattle INSURER c:State National Insurance Company, I 12831 <br /> Catholic Community Services LP 325; <br /> 1918 Everett Ave INSURER D <br /> Everett WA 98201 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 1269740543 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 SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) LIMITS <br /> A x COMMERCIAL GENERAL LIABILITY Y BP1023016 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR lPREMISES(Ea occurrence) $1,000,000 <br /> MED EXP(Any one person) $NII <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$1,000,000 <br /> X POLICY PRO- <br /> JECT LOC PRODUCTS-COMP/OPAGG $1,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY BP1023016 7/1/2016 7/1/2017 COMBINED SINGLE LIMIT $1 000,000 <br /> (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED ' SCHEDULED ,'. BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS 1 <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per accident) <br /> $ <br /> B UMBRELLA LIAB X OCCUR 821600 0785428 7/1/2016 7/1/2017 EACH OCCURRENCE _ $5,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION BP1023016 7/1/2016 7/1/2017 X <br /> PER OTH- <br /> C AND EMPLOYERS'LIABILITY Y/N NDE-0864110-16 7/1/2016 7/1/2017 STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> i <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Limits shown for insurer A& B are inclusive of defense and insured retention <br /> Certificate Holder is included as Additional r ontract or agreement per attached endorsement on the policy. Coverage <br /> only extends for claims arising out of Cathol CS� Ilfillment of their obligations as outlined in the Community Development <br /> Block Grant Agreement with the City of Everett, ort e term o t e certificate. <br /> AUG 1 8 2016 <br /> CITY OF EVERETT <br /> CERTIFICATE HOLDER PLANNING DEPT CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Everett, its officers, employees and agents THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 2930 Wetmore Ave. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett WA 98201 <br /> USA AUTHORIZED REPRESENTATIVE <br /> I <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />