Work Force Development Center 2/22/2017

,-----N ® DATE(MM/DDIYYYY) AW D CERTIFICATE OF LIABILITY INSURANCE 4/5/2017 _ 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 NAME: HUB International Northwest LLC PHONE(A//C.No.Ext)360-647-9000 (A/C,No ):360-734-8496 110 Unity Street E-MAIL Bellingham WA 98225 ADDRESS:now.unityinfo@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:General Insurance Company of Americ 24732 INSURED WORKF-1 INSURER B: Work Force Development Center INSURER C: 11400 Airport Road Suite 100 INSURER D: Everett WA 98204 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:426164608 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY Y Y 24CC3040805 9/1/2016 9/1/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X $1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 . PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 PR - 7 POLICY JECT X LOC $ A AUTOMOBILE LIABILITY 24CC3040895 9/1/2016 9/1/2017 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) _$ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 24CC3040805 9/1/2016 9/1/2017 WC STATU- x 0TH- WA Stop Gap AND EMPLOYERS'LIABILITYYIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $3,000,000 A Property 24CC3040805 9/1/2016 9/1/2017 Max Limit 5,006,250 Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Per policy forms and conditions: Liability Plus Endorsement form CG 76 35 02 07. City of Everett, its officers, employees and agents are included. 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 8-A ACCORDANCE WITH THE POLICY PROVISIONS. Everett WA 98201-4067 AUTHORIZED REPRESENTATIVE �(�, / I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD