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e ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/20/2017 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 Tiffany Brewster PLC Insurance, LLC PH No 6O (425)712-3664 xtk No):(425)712-3786 4211 Alderwood Mall Blvd, #210 n-ooRIEss:tiffany@plcins.com INSURER(S)AFFORDING COVERAGE NAIL It Lynnwood WA 98036 INsuRERA:Berkshire Hathaway Spec Ins Co INSURED INSURER B: Work Opportunities, Inc. INSURERC: 6515 - 202nd St. SW INSURERD: INSURER E: Lynnwood WA 98036-5998 • INSURERF: COVERAGES CERTIFICATE NUMBER:17/18 GL/AUTO 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 I TYPE OF INSURANCE ADM_SUBR POUCY EFF POLICY EXP LTR INSD„..t/VD POUCY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TED A !CLAIMS-MADE IOCCUR PREMSES(EaJ rXoccurrence) $ 250,000 47SPX14849802 1/1/2017 1/1/2018 MEDEXP(Anyoneperson) $ 10,000 PERSONAL BADV INJURY $ 1,000,000 hGEN'L AGGREGATE LIMIT APPLIES PER: PRO- GENERAL AGGREGATE $ 3,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO I BODILY INJURY(Per person) $ ^ ALL OWNED SCHEDULED 47RWS14849902 1 1/2017 1/1/2018 BODILY INJURY(Per $ AUTOS AUTOS / ( ) NON-OWNED PROPERTY DAMAGE $ _. AUTOS (Per accident) HIRED AUTOS I _ I Medical payments $ 5,000 UMBRELLA UAB OCCUR I EACH OCCURRENCE $ —1 EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED RETENTION$ { $ WOXICIMCOlieakliMX WA Stop Gap / Employer's PER 0TH-(EMPLOYERS'LIABILITY YIN STATUTE X ER }ANY PROPRIETOR/PARTNER/EXECUTIVE Liability E.L.EACH ACCIDENT $ 1 000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) 475PR14849802 1/1/2017 1/1/2018 E.L.DISEASE-EA EMPLOYEE$ 1,000 00.0 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT,$ 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (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 included as an additional insured as required by written contract per attached CG2026 0413. CERTIFICATE HOLDER CANCELLATION rjohnson@everettwa.gov 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 Ste. 8A ACCORDANCE WITH THE POLICY PROVISIONS. Everett, WA 98201 AUTHORIZED REPRESENTATIVE Darwin Rieck/ASHLEY _.-=...—.- v �-dt'c ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7mnm r