Community Health Center 11/21/2016

CERTIFICATE OF LIABILITY INSURANCE DATE / ) 08/24/24/20162016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Parker,Smith&Feek,Inc. PHONEIA/C425-709-3600 I FAx 425-709-7460 E-M 2233 112th Avenue NE No.Ee . (AIC,No): E-MAIL Bellevue,WA 98004 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Physicians Insurance A Mutual Company INSURED INSURER B: Community Health Center of Snohomish Co 8609 Evergreen Way INSURER C: Everett,WA 98208 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER (MMIDCY D/YYYY),(MMIDDIYYY) LIMITS A GENERAL LIABILITY 300002865 6/1/2016 6/1/2017 EACH OCCURRENCE $ 1,000,000 _ X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 000,000 X PREMISES(Ea occurrence) $ X CLAIMS-MAA OCCUR MED EXP(Any one person) $ 25,000 PERSONAL&ADV INJURY $ Included X Retro Date:06/01/2016 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ Included XX� POLICY JE? LOC $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Perid $ AUTOS AUTOS accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ A WORKERS COMPENSATION 300002865 X WC STATU-TORY LIMITS OT AND EMPLOYERS'LIABILITY Y/N 6/1/2016 6/1/2017ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Adult Dental Care for the Uninsured The City of Everett,its officers,employees and agents are additional insured on the general liability policy.Endorsement to follow.CANCELS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Everett Department of Planning& ACCORDANCE WITH THE POLICY PROVISIONS. Community Development 2930 Wetmore Avenue,Suite 8A AUTHORIZED REPRESENTATIVE Everett,WA 98201 ,r ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD COMMHECE(EKM01)