ARC of Snohomish County 3/23/2017

r r ASG®� D/ CERTIFICATE OF LIABILITY INSURANCE DATE 7/11/2016 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(les)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 Select NAME: PLC Insurance, LLC �PpH�cONtE&Ext1 (425)712-3664 ( N0):(425)712- 3756 4211 Alderwood Mall Blvd, #210 DA $;corriniplcins.com INSURERS)AFFORDING COVERAGE NAC$ Lynnwood WA 98036 IssuRERAphiladelphia Indemnity Ins Co. INSURED INSURER B: The Arc of Snohomish County INSURER C: 6515 202nd St SW INSURER D: INSURER E: Lynnwood WA 98036 INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 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. IL7R TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP „INSILWYD POUCY NUMBER (MM/DD/YYYY)JMMIOD/YYVY) UNITS X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE n OCCUR DAMAGE TO RENTED ' PREMISES Ma occurrence) $ 100,000 PEPE1488926 6/22/2016 6/22/2017 MEDEXP(Myone poison) $ 5,000 PERSONAL&AIN INJURY_ $ 1,000,000 GENLAGGREGATEUMITAPPLIESPER: GENERAL AGGREGATE _ $ 2,000,000 X POLICY J TiLOC PRODUCTS-COMP/OPAGG $ 2,000,000~ n OTHER: Employers LlabEty-Stop Gap $ 1,000,000 AUTOMOBILE UABIUTY (CEIOMBcN SINGLE LIMIT $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL UTO ED SCHEDULED PIDTE1408926 6/22/2016 6/22/2017 BODILY INJURY(Per accident) $ X HIRED AUTOS % NON-OWNED (PPROPERTY DAMAGE _ AUTOS er accidan0 $ $ UMBRELLA UAB I OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS _ $ )810088W880860308( WASHINGTON STOP GaP PER 0TH_ (MPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE SMEL EACH ACCIDENr PLOTER'S LIABILITY OFFICER/MEMBEREXCLUDED? nN/A $ 1,000,000 A NydON(Mandatoryin NH) PEPX1488926 6/22/2016 6/22/2017 EL DISEASE-EA EMPLOYEE$ 1,000,000 DESCRIPTIOF OPERATIONS belowE.L DISEASE-POUCY UMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEMCLES(ACORD 101,Additional Remarks Schedule,may be attached IF more space Is required) RE: Grant Funding City of Everett, its officers, employees and agents are additional insureds per the attached CG2026 (07/04) . 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 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Suite 8A Everett, WA 98201 AUTHORIZED REPRESENTATIVE Mike Rucker/CORRIN ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7014n11