Everett United Church of Christ 2/22/2017

A a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 12/20/2016_ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS I IS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CO' S BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN T ''"w d D REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _ IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. o the terms and conditions of the policy,certain policies may require an endorsement. A statement on thi e certificate holder in lieu of such endorsement(s). _ PRODUCER CONTACT CL Central % 1 Leavitt Group Northwest (A/c No.Extl 866-298-0570 � � — PO Box 9068 E-MAIL ADDRESS:cicnorthwest(�lea .J INSURER(S)AFFORD'Nu t-uvERAGE NAIC# Tacoma WA 98490 INsuRERA:Great American Insurance Company C16691 INSURED INSURER B: Everett United Church of Christ INSURER C: 2624 Rockefeller Ave INSURERD: - INSURER E: Everett WA 98201 INSURER F: - COVERAGES CERTIFICATE NUMBER:17/18 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. ILTRR TYPE OF INSURANCE NSD SWVD POLICY NUMBER (MM/DUBR DIYYYY) (FF MM/DDIY EXP ADDL LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 • DAMAGE TO A CLAIMS-MADE X OCCUR PREMISES(EaEcTED occurrence) $ 100,000 X PAC409533302 1/1/2017 1/1/2018 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER _GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 _ JECT - OTHER: $ AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A _ ALL OWNED SCHEDULED AUTOS AUTOS PAC409533302 1/1/2017 1/1/2018 BODILY INJURY(Per accident) $ X HIRED AUTOS X AUT SEED (Per acciid DAMAGE $ —$ III UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 IINB409533402 1/1/2017 1/1/2018 $ WORKERS COMPENSATION PER X OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA E.L.EACH ACCIDENT $ 1,000,000 OFF1CA (Mandatory NH )BER EXCLUDED? PAC409533302 1/1/2017 1/1/2018 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below WA Stop Gap EL DISEASE-POLICY OMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) City of Everett is named additional insured with respects to general liability per written contract with the named insured form CG89701114. 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 Department of Planning and ACCORDANCE WITH THE POLICY PROVISIONS. Community Development 2930 Westmore Avenue AUTHORIZED REPRESENTATIVE Suite 8A - Everett, WA 98201 D zcTrammell/DITRAM ''4_.)C0:X1t. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)