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<br /> +� .'ER'IP,1 I�Ai �.. ,� e� t .' rE Date: 05/18/2018
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
<br /> NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT
<br /> BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTAT IVE OR PRODUCER,AND THE CERT IFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGRATION IS WAIVED,subject to the terms and conditions of
<br /> 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).
<br /> PRODUCER COMPANIES AFFORDING COVERAGE
<br /> GENERAL LIABILITY
<br /> Clear Risk Solutions American Alternative Insurance Corporation,et al.
<br /> 451 Diamond Drive
<br /> Ephrata, WA 98823 AUTOMOBILE LIABILITY
<br /> American Alternative Insurance Corporation,et al.
<br /> INSURED
<br /> PROPERTY
<br /> Senior Services of Snohomish County American Alternative Insurance Corporation,et al.
<br /> dba Homage Senior Services
<br /> 11627 Airport Road, Suite B MISCELLANEOUS PROFESSIONAL LIABILITY
<br /> Everett, WA 98204 Princeton Excess and Surplus Lines Insurance Company
<br /> COVERAGES
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD
<br /> INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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 PAID CLAIMS.
<br /> TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP DESCRIPTION - LIMITS
<br /> DATE DATE
<br /> GENERAL LIABILITY
<br /> COMMERCIAL GENERAL LIABILITY N1-A2-RL-0000013-09 06/01/2018 06/01/2020 PER OCCURRENCE $5,000,000
<br /> OCCURRENCE FORM PER MEMBER AGGREGATE $10,000,000
<br /> INCLUDES STOP GAP PRODUCT-CO MP/OP $5,000,000
<br /> PERSONAL&ADV.INJURY $5,000,000
<br /> (LIABILITY IS SUBJECT TO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $50,000,000
<br /> AUTOMOBILE LIABILITY -
<br /> ANY AUTO N1-A2-RL-0000013-09 06/01/2018 06/01/2020 COMBINED SINGLE LIMIT $5,000,000
<br /> (LIABILITY IS SUBJECT TO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE
<br /> PROPERTY
<br /> N1-A2-RL-0000013-09 06/01/2018 06/01/2020 ALL RISK PER OCC EXCL EQ&FL $75,000,000
<br /> EARTHQUAKE PER OCC EXCLUDED
<br /> FLOOD PER OCC EXCLUDED
<br /> (PROPERTY IS SUBJECT TO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE
<br /> MISCELLANEOUS PROFESSIONAL LIABILITY
<br /> N1-A3-RL-0000060-09 06/01/2018 06/01/2020 PER CLAIM $1,000,000
<br /> (LIABILITY IS SUBJECT TO A $50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $40,000,000
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS1 VEHICLES/SPECIAL ITEMS
<br /> Regarding social work services provided at Carl Gipson Senior Center.City of Everett,its officers, employees and agents are
<br /> named as Additional Insured regarding these services only and are subject to policy terms,conditions and exclusions.
<br /> CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE
<br /> WITH THE POLI CY PROVISIONS.
<br /> CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE
<br /> City of Everett (\� /
<br /> 3025 Lombard Ave .O I
<br /> Al
<br /> Everett,WA 98201
<br /> 3401181
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