Domestic Violence Service of Snohomish County 12/27/2017 Amendment 1

A oR a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIVYYY) 11/8/2017 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(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 Debbie Cook _NAME: Leavitt Group Northwest ? 0 )_ (425)258-2300 FAX (425)258-9363 PO Box 9068 E-MIL debbie-cook@leavitt.com A_,pOREM INSURER(S)AFFORDING COVERAGE NAIC A Tacoma WA 98490 INSURERAGreat American Insurance Company C16691 INSURED _INSURER B: Domestic Violence Services of Snohomish County INSURER C: PO Box 7 INSURER D: INSURER E: Everett WA 98206-0007 INSURERF: COVERAGES CERTIFICATE NUMBER:2017-1B 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. INSR TYPE OF INSURANCE ArtiLISUBR- - POLICY EFF POLICY EXP LTR IN5D I WVD POLICY NUMBER (MMIDDIYYYY) IMMIODIYYYYi LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A I CLAIMS-MADE XJ OCCUR DAMAGE TO RENTED $ 100,000 PREMl,.ES fEe occurr9()cs1 X PAC059525504 10/10/2017 10/10/2018 MEDEXP(Anyoneperson) $ 5,000 PERSONAL 8 ADV INJURY _$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X IPOLICY J TER 1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER Stop Gap Employee BI by $ 1,000,000 AUTOMOBILE LIABILITY • COMBINED SINGLE MBIINGLEUMIT 1,000,000 (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED --SCHEDULED CAP59525604 AUTOS 10/10/2017 10/10/2018 BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (PeraceldenI Underinsured motorist $ 1,000,000 A... UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2_,000,000 A EXCESSLIAO CLAIMS-MADE UMB059525704 10/10/2017 10/10/2017 AGGREGATE $ 2,000,000 DED RETENTION$ WORKERS COMPENSATION PER x ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE r Ni NIA WA Stop Gap E,L EACH ACCIDENT $ 1,000,000_ OFFICER/MEMBERdry NH)EXCLUDED? ( PAC059525504 10/10/2017 10/10/2018 E, DISEASE-EA EMPLOYEE $ 1,000,000 A (Mandatory In NH) L If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) The City of Everett, Its officers, employees and agents are named as an additional insured as per terms and conditions of form CG2026 04 13 attached. 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 #BA ACCORDANCE WITH THE POLICY PROVISIONS. Everett„ WA 98201 AUTHORIZED REPRESENTATIVE Jeff Olsen/DECOOK 0 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011