Boys and Girls Club of Snohomish County 12/27/2017

Client#: 326528 BOYSGIRI ' ACORDTC CERTIFICATE OF LIABILITY INSURANCE DATE 612(MWDD/(MMIDD/YYYY) 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(les)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 Please send all requests by USI Kibble&Prentice I PHONE fax or email FAR 610-362-8518 601 Union Street,Suite 1000 E.MAae'Eat). ��wc,Noh. ADDREss: CLCertRequest@usi.com Seattle,WA 98101 206-441-6300 INSURERS)AFFORDING COVERAGE NAIL# INSURER A:Great American Alliance Ins Co 26832 INSURED 1 INSURER B:Berkley Regional Insurance Co 29580 Boys&Girls Clubs of Snohomish County 9502 19th Ave SE,Ste F INSURER C INSURER D: Everett,WA 98208 INSURER E: _ ` INSURER F: COVERAGES CERTIFICATE NUMBER: K2 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 1LIMITS LTR, TYPE OF INSURANCE IN$R WYD POLICY NUMBER (MM/DD/YYYY)�(MM/DDNYYY)_I -. _. A X, COMMERCIAL GENERAL LIABIUTY PAC052125704 07/06/2017107/06/2018 EACH OCCURRENCE $1,000,000 ppgqMMgqGGEE 77Q I CLAIMS-MADE I XI OCCUR 1 PREMtSES(Ea oNciurrence) 15300,000 XI WA Stop Gap/EL MED ExP(Any one person) $15=000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE_ LIMIT APPLIES PER: I GENERAL AGGREGATE 1E2 000 000 POLICY i I ECT I.x I LOC ,PRODUCTS-COMP/OPAGG s2,000,000, . OTHER WA Stop Gap_ I$1,000,000 A AUTOMOBILE LIABILITY CAP052125804 07/06/2017107106/201 aLE°"aTdo°tSINGLE LIMIT !$1,000,000 - _ I X ANY AUTO I BODILY INJURY(Per person) I$ ALL OWNED SCHEDULEDAUTOS BODILY INJURY(Per accident) $ ON-OWNED ,PROPERTY DAMAGE S X! HIRED AUTOS !I X AUTOS 1.(Peracddent)_ -_ S A ___)( UMBRELLA UAB i OCCUR'X UMB052125904 07/06/2017 07/06/2018 EACH $1 I OCCURRENCE 0,000,000 .EXCESS LIAR I CLAIMS-MADE XS of GL,Auto& AGGREGATE $104000,000 DEO I X1 RETENTIONs10,000 Employers Liab, _ $ WORKERS COMPENSATION I PER OTH•I AND EMPLOYERS'LIABILITY Y 1 N _.___ i STATUTE- I ER. __ ANY PROPRIETORIPARTNER/EXECUTIVE-- E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1 N/A (Mandatory In NH) 'E.L.DISEASE-EA EMPLOYEE'$ _____ _ If yes,describe under _ DESCRIPTION OF OPERATIONS below _ _ _.- _ I E.L.DISEASE-POLICY LIMIT $ B CRIME/FIDELITY BCCR4500149322 07/06/2017 07/06/2018' $400,000 Employee Theft I $2,500 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Any and all grants.The City of Everett,its officers,employees and agents are Additional Insured as respects General Liability per attached endorsement CG2026 07/04. CERTIFICATE HOLDER CANCELLATION ANYELLED City of Everett THELD EXP RATTIIONH DATE E V THEREOF,E E NOTICE ES WILL E CBE CDE IVER DO IN Dept of Planning&Community Development ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore,Suite 8A Everett,WA 98201 AUTHORIZED REPRESENTATIVE 4. ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S20824707/M20824682 CNMJU