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1301 Second Avenue,Suite 2700 <br /> Physicians le,WA 91220 8111 <br /> 4.5 Box <br /> Seattle, <br /> 343-77300 <br /> Insurance (800l 962-1399 <br /> A MUTUAL COMPANY F(206)3437100 <br /> Healthcare Facility Professional And General Liability Insurance Policy <br /> ADDITIONAL INSURED - DESIGNATED ORGANIZATION ENDORSEMENT <br /> As of the endorsement effective date until the endorsement expiration date, the designated organization shown <br /> below is an additional insured under this policy on a shared limits basis under the coverage part(s) <br /> designated below. <br /> ENDORSEMENT ENDORSEMENT <br /> EFFECTIVE EXPIRATION COVERAGE <br /> ORGANIZATION NAME: DATE DATE PREMIUM PART(S) <br /> The City of Everett, its officers, 8/1/2016 6/1/2017 N/A D <br /> employees and agents, 2930 <br /> Wetmore Ave Ste 8A Everett WA <br /> 98201 <br /> With respect to the insurance afforded to this additional insured, the following is added to Section VIII. <br /> LIMITS OF INSURANCE: <br /> The most the Company will pay on behalf of the additional insured is the amount of insurance: <br /> 1. required by the contract or agreement with the insured: or <br /> 2. available under the applicable Limits of Insurance shown in the Declarations: <br /> whichever is less. <br /> This endorsement shall not increase or decrease the applicable Limits of Insurance shown in the Declarations. <br /> Page 1 of 2 <br /> Named Insured's Name&Address: Policy Number 300002865 <br /> Community Health Center of Snohomish County Effective Date&Expiration Date 06/01/16-06/01/17 <br /> 8609 Evergreen Wy <br /> Everett,WA 98208 Endorsement Effective Date August 1,2016 <br /> Authorized Signature: <br /> This endorsement is subject to the declarations, conditions.exclusions and all other terms of the policy indicated above <br /> which are riot inconsistent with this endorsement and forms a part of that policy when signed by an authorized representative <br /> of the company. <br /> END420-PIHPL.123115 08/30/16 300223 396270 <br />