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<br /> ARD® CERTIFICATE OF LIABILITY INSURANCE DAT/(T/2017 Y)
<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(les) 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 CONTACT Debbie Cook
<br /> NAME:
<br /> Leavitt Group Northwest ((A/C,No.Ext): (425)258-2300 FAX No):(425)258-9363
<br /> PO Box 9068 E-MAIL
<br /> ADDRESS:debbie-cook@leavitt.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Tacoma WA 98490 INSURER A:Philadelphia Indemnity Insurance A18058
<br /> INSURED INSURER B Hartford Casualty Insurance Company 029424
<br /> United Way of Snohomish County INSURER C:
<br /> 3120 McDougall Ave #200 INSURERD:
<br /> INSURER E: _
<br /> Everett WA 98201-4433 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:2017-18 Master 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 (MMIDD/YYYY) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY 1,000,000
<br /> EACH OCCURRENCE $
<br /> A CLAIMS-MADE X OCCUR PRTORENTED PREEMIMI DAMAGE SES){Ea occurrence) $ 100,000_
<br /> X PHPK1581617 1/18/2017 1/18/2018 MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY PRO-
<br /> JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> •AUTOMOBILE LIABILITY (Ea BINEDaccidentSINGLE LIMIT $ 1,000,000
<br /> A ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED —
<br /> SCHEDULED UTOS PHPK1581617 ' 1/18/2017 1/18/2018 BODILY INJURY(Per acddent) $
<br /> AUTOS N
<br /> X HIRED AUTOS X $
<br /> AUTOS NON-OWNED PROPERTY DAMAGE(Per accident)
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
<br /> A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
<br /> DED X RETENTION$ 10,000 PHUH564747 1/18/2017 1/18/2018 $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE X ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Gap E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICERA (Mandatory TinEXCLUDED? NIA PHPK1581617 1/18/2017 1/18/2018
<br /> ( ry 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 /> B Directors & Officers NOA1317837 7/29/2016 7/29/2017 D&O Liability 3,000,000
<br /> Employment Practices Liability 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> City of Everett, its officers, employees and agents are additional insured per terms and conditions of
<br /> form CG2026 07/04, attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Department of Planning ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> and Community Development
<br /> 2930 Wetmore Avenue, Suite BA AUTHORIZED REPRESENTATIVE
<br /> Everett, WA 98201 �/
<br /> D Whitfield, CPCU/DEC /^-`�►
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(2014011
<br />
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