Work Force Development Center 2/7/2018

• ' � l ® ,4� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/8/2018 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: Kris Gillen HUB International Northwest LLC PHONE FAX 110 Unity Street (A/CANo.Ext):360-647-9000 (A/C,No):360-734-8496 Bellingham WA 98225 ADDRESS: now.bellinghaminfo@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:General Insurance Company of America 24732 INSURED WORKF-1 INSURER B: Work Force Development Center 11400 Airport Road Suite 100 INSURER C: Everett WA 98204 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:489634211 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DDIYYYY) A GENERAL LIABILITY Y Y 24CC3040806 9/1/2017 9/1/2018 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $1,000,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO X LOC $ JECT A AUTOMOBILE LIABILITY 24CC3040896 9/1/2017 9/1/2018 COMBINED SINGLE LIMIT (Ea accident) $1.000,000 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 24CC3040806 9/1/2017 9/1/2018 WC STATU- X OTH- WA Stop Ga AND EMPLOYERS'LIABILITY Y/N TORY)IMITS ER p p ANY PROPRIETOR/PARTNER/EXECUTIVEN/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 $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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. RE:Award of 2018 Human Needs Grant for WFDC Vocational Training and Apprenticeship Program. City of Everett,its officers,employees and agents are included. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. Dept. of Planning&Community Devel. Attn: Rebecca McCrary 2930 Wetmore Ave Ste 8-A AUTHORIZED REPRESENTATIVE Everett WA 98201-4067 a(b/. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD