|
ACCPRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> fir....--' 11/8/2017
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Debbie Cook
<br /> NAME;
<br /> Leavitt Group Northwest HON,"�Ep.F�SI: (425)258-2300 F 4)s(125)4se-9363
<br /> PO Box 9068AX
<br /> 'Mdll debbie-cook@leavitt.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC F
<br /> Tacoma WA 98490 INSURER A:Great American Insurance Company C16691
<br /> INSURED INSURER B:
<br /> Domestic Violence Services of Snohomish County INSURER C:
<br /> PO Box 7 INSURER D
<br /> INSURER E:
<br /> Everett WA 98206-0007 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:2017-18 Master REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDpCLAIMS.
<br /> 1Y EFF
<br /> R T TYPE OF INSURANCE NSD WVD POLICY NUMBER ,(MMI CODIYYYYI{ O
<br /> NSRIADDUSUBR xyPyi LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> O
<br /> A ___, CLAIMS-MADE LX I OCCUR PREMISE I RENTED 100,000
<br /> PREMISES Ea occurrence) $
<br /> X PAC059525504 10/10/2017 10/10/2018 MEDEXP(Anyone person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $ 2,000,000-
<br /> -i-
<br /> ,000,000X POLICY JEcr PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> .._. J JEC7 LOG
<br /> OTHER Stop Gap Employee BI by $ 1,000,000
<br /> AUTOMOBILE LIABILITY TEs COMMFEDIWGLEUMa $ 1,000,000 socideti,
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A ALL OWNED SCHEDULED
<br /> CAP59525604 10/10/2017 10/10/2018 BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON OWNED PROPERTYt1RMAGE
<br /> HIRED AUTOS AUTOS
<br /> CPf.187 Wenn $
<br /> Underinsured motorist $ 1,000,000
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> A EXCESS LIAB CLAIMS-MADE UMB059525704 10/10/2017 10/10/2017 AGGREGATE $ 2,000,,000
<br /> DED f RETENTION$ , $
<br /> WORKERS COMPENSATION PER X OTM'
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE j(Y I N1 WA Stop Gap EL EACH ACCIDENT $ 1,000,000
<br /> A (Mandatory
<br /> In NOFFICER/MEMBER EXCLUDED? j,,,,__J NIA PAC059525504 10/10/2017 10/10/2018 E L DISEASE-EA EMPLOYEE$ 1 000 000
<br /> (Mandatory In NH) a _ r
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIQN$below E.L.DISEASE-POLICY LIMIT 1$ 1,000.,000
<br /> DESCRIPTION OF OPERATIONS)LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> The City of Everett, Its officers, employees and agents are named as an additional insured as per terms
<br /> and conditions of form CG2026 04 13 attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 2930 Wetmore Ave Ste #8A ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett„ WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> Jeff Olsen/DECOOK SW;
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(91114011
<br />
|