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RECE1V. <br /> MAY 2 2�1,� CampFSC5lrevised <br /> Non Profit Insurance Progran1L NINE DEPS-? <br /> CERTIFICATE OF COVERAGE Issue Date: 05/23/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON VERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES <br /> NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT <br /> BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGRATION IS WAIVED,subject to the terms and conditions of <br /> the policy,certain coverage may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER COMPANIES AFFORDING COVERAGE <br /> GENERAL LIABILITY <br /> Clear Risk Solutions American Alternative Insurance Corporation <br /> 451 Diamond Drive <br /> Ephrata, WA 98823 AUTOMOBILE LIABILITY <br /> American Alternative Insurance Corporation <br /> INSURED <br /> PROPERTY <br /> Camp Fire Snohomish County American Alternative Insurance Corporation, et al. <br /> 4312 Rucker Avenue MISCELLANEOUS PROFESSIONAL LIABILITY <br /> Everett WA, 98203 Princeton Excess and Surplus Lines Insurance Company <br /> Torus Specialty Insurance Company <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD <br /> INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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 /> TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP DESCRIPTION LIMITS <br /> DATE DATE <br /> GENERAL LIABILITY <br /> COMMERCIAL GENERAL LIABILITY N1-A2-RL-0000013-08 06/01/2016 06/01/2018 PER OCCURRENCE $5,000,000 <br /> OCCURRENCE FORM PER MEMBER AGGREGATE $10,000,000 <br /> INCLUDES STOP GAP PRODUCT-CO MP/OP $5,000,000 <br /> PERSONAL&ADV.INJURY $5,000,000 <br /> (LIABILITY IS SUBJECTTO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $50,000,000 <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO N1-A2-RL-0000013-08 06/01/2016 06/01/2018 COMBINED SINGLE LIMIT $5,000,000 <br /> (LIABILITY IS SUBJECTTO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE <br /> PROPERTY <br /> N1-A2-RL-0000013-08 06/01/2016 06/01/2018 ALL RISK PER OCC EXCL EQ&FL $75,000,000 <br /> EARTHQUAKE PER OCC EXCLUDED <br /> FLOOD PER OCC EXCLUDED <br /> (PROPERTY IS SUBJECTTO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE <br /> MISCELLANEOUS PROFESSIONAL LIABILITY <br /> N1-A3-RL-0000060-07 06/01/2016 06/01/2018 PER CLAIM $2,000.000 <br /> (LIABILITY IS SUBJECTTO A $50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $40,000,000 <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES/SPECIAL ITEMS <br /> Regarding the City of Everett Community Development Block Grant award. The City of Everett, <br /> its officers, employees, and agents are named as Additional Insureds regarding this grant award only and are subject to policy <br /> terms, conditions, and exclusions. <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE <br /> WITH THE POLI CY PROVISIONS. <br /> CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE <br /> 1(�City of Everett Planning&Community Development • <br /> 2930 Wetmore Ave, Ste 8-A <br /> Everett,WA 98201 <br /> 3116293 <br />