Domestic Violence Services 1/12/2017

AC: D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/13/2016 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 Debbie Cook NAME: Leavitt Group Northwest 1Pi4HC.No,Ext.):ONE (425)258-2300 (p/C,No):(425)258-9363 PO Box 9068 E-MAIL debbie—cook@leavitt.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 8 Tacoma WA 98490 INsuRERAGreat American Insurance Company C16691 INSURED INSURER B Domestic Violence Services of Snohomish County INSURERC: PO Box 7 INSURER D: INSURER E: Everett WA 98206-0007 INSURERF: COVERAGES CERTIFICATE NUMBER:2016-17 Master 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSD VD POLICY NUMBER (MMIDDIYYYY) IMMIDD/YYYYI X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES PREMISES(Ea occurrence) $ X PAC59525503 10/10/2016 10/10/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER Professional liabili $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALTL OWNED SCHEDULED CAP59525603 10/10/2016 10/10/2017 BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) _ Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTIONS 10,000 UMB59525703 10/10/2016 10/10/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT NIA A $ OFFICER/MEMBER EXCLUDED? -- _ __-- (Mandatory In NH) PAC59525503 10/10/2016 10/10/2017 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - DESCRIPTION PERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Everett, Its officers, employees and agents are named as an additional insured as per terms and conditions of form CG2026 04 13 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2930 Wetmore Ave Ste #8A ACCORDANCE WITH THE POLICY PROVISIONS. Everett„ WA 98201 AUTHORIZED REPRESENTATIVE Jeff Olsen/DECOOK C -�O ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011