Homage Senior Services of Snoh County 12/19/2017

SeniSSC117 Non Profit Insurance Program CERTIFICATE OF COVERAGE Issue Date: 05/20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUE 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 SUBROGRATION IS WAIVED,subject to the terms and conditions of the policy,certain coverage may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COMPANIES AFFORDING COVERAGE GENERAL LIABILITY Clear Risk Solutions American Alternative Insurance Corporation 451 Diamond Drive Ephrata,WA 98823 AUTOMOBILE LIABILITY American Alternative Insurance Corporation INSURED PROPERTY Senior Services of Snohomish County American Alternative Insurance Corporation,et al. 11627 Airport Road, Suite B MISCELLANEOUS PROFESSIONAL LIABILITY Everett WA, 98204 Princeton Excess and Surplus Lines Insurance Company Torus Specialty Insurance Company COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP DESCRIPTION LIMITS DATE • DATE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY N1-A2-RL-0000013-08 06/01/2016 06/01/2018 PER OCCURRENCE $5,000,000 • OCCURRENCE FORM PER:MEMBER AGGREGATE $10,000,000 INCLUDES STOP GAP PRODUCT-CO MP/OP $5,000,000 PERSONAL&ADV.INJURY $5,000,000 (LIABILITY IS SUBJECTTO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $50,000,000 AUTOMOBILE LIABILITY ANY AUTO N1-A2-RL-0000013-08 06/01/2016 06/01/2018 COMBINED SINGLE LIMIT $5,000,000 (LIABILITY IS SUBJECTTO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE PROPERTY N1-A2-RL-0000013-08 06/01/2016 06/01/2018 ALL RISK PER OCC EXCL EQ&FL $75,000,000 EARTHQUAKE PER DCC EXCLUDED FLOOD PER OCC EXCLUDED (PROPERTY IS SUBJECTTO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE MISCELLANEOUS PROFESSIONAL LIABILITY N1•A3-RL-0000060-07 06/01/2016 06/01/2018 PER CLAIM $2,000,000 (LIABILITY IS SUBJECT TO A $50,000 SIR PAYABLE FROM PROGRAM FUNDS1 ANNUAL POOL AGGREGATE $40,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I SPECIAL ITEMS Regarding social work services provided at Carl Gipson Senior Center.City of Everett,its officers,employees and agents are named as Additional Insured regarding these services only and are subject to policy terms, conditions and exclusions. CANCELLATION SHOULD ANY OF THE APOVE DE.,CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLI CY PROVISIONS. CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE City of Everett (A14 I f 3025 Lombard Ave • . Everett,WA 98201 3111436