Catholic Community Services 2/22/2017

DATE(MM/DD/YYYY) ACoRD® CERTIFICATE OF LIABILITY INSURANCE 3/16/2017TE(MMI 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). CONTAPRODUCER NAME: Stephen Erni Arthur J. Gallagher Risk Management Services, Inc. PHONE 425-454-3386 FAX 425-451-3716 777 108th Ave NE,#200 (A/c,No.ExtpINC.No); Bellevue WA 98004 ADDRESS:Stephen_Erni@ajg.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Underwriters at Lloyd's London 15792 INSURED CORPOFT-01 INSURERB:Old Republic Union Insurance Compan 31143 Corporation of the Catholic Archbishop of Seattle INSURER c:State National Insurance Company, I 12831 Catholic Community Services LP 317; 1133 Railroad Ave., Suite 100 INSURER D: Bellingham WA 98225 INSURER \/j/�/ S INSURER . /J� / i/�/�I .'V L�J COVERAGES CERTIFICATE NUMBER:342314496 Cr ��/L/(//l�/' Ill�[ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I ERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY �j� THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TH ` c 4 4 0 , V—n� ERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN RE INSR ADDL SUBR p LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (M A X COMMERCIAL GENERAL LIABILITY Y BP1023016 7/1' / / if71.5eirle4-4— di. , CLAIMS-MADE X OCCUR tT///n�eadC/ v . GEN'L AGGREGATE LIMIT APPLIES PER: /n e�///n_ X POLICY PRO LOC (v JECT OTHER: Lt:1/4-11tadtier ., ,. . ` A AUTOMOBILE LIABILITY BP1023016 7/1 X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X . . . AUTOSNON-OWNED ' ,.. B UMBRELLA LIAB X OCCUR 821600 0785428 7/1/2016 7/1/2017 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION BP1023016 7/1/2016 7/1/2017 OTHX C AND EMPLOYERS'LIABILITY Y/N NDE-0864110-16 7/1/2016 7/1/2017 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 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 $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Limits shown for insurer A & B are inclusive of defense and insured retention City of Everett, its officers, employees and agents are included as Additional Assured. Coverage only extends for claims directly arising out of the Human Needs Grant contract between City of Everett and Catholic Community Services for the term of the certificate. 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,Suite 8A ACCORDANCE WITH THE POLICY PROVISIONS. Everett WA 98201-4044 AUTHORIZED REPRESENTATIVE 8",„(x1.-Xic-0/.11:),<-0.--( I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD