Everett Family YMCA 12/18/2018 - Laserfiche WebLink

A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/5/2018 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 Michelle Parker NAME: Leavitt Group Northwest IANC NNo,Ext): (800)726-8771 (A/C ,No1:(866)728-9168 PO Box 65770 E-MAILDRESS:michelle-parker@leavitt.com AD INSURER(S)AFFORDING COVERAGE - NAIC# University Place WA 98464 INSURERA:North River Insurance Company 021105 INSURED INSURERB:United States Fire Insurance 021113 YMCA of Snohomish County INsuRERc:Philadelphia Insurance Company 123850 Scott Washburn INSURERD: _ 2720 Rockefeller Ave INSURERE: Everett WA 98201 INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE X OCCUR PREMSESO(Ea occurrence) $ 100,000 X 5068946934 9/1/2018 9/1/2019 _MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO- JECT - X LOC PRODUCTS COMP/OP AGG $ 1,000,000 OTHER: RentedTo You $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED 5068946934 9/1/2018 9/1/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS _ NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) _ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 0 5821108452 9/1/2018 9/1/2019 $ WORKERS COMPENSATION PERx OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000_ OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) 5068946934 9/1/2018 9/1/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under Stop DESCRIPTION OF OPERATIONS below Washington Ga p E.L.DISEASE-POLICY LIMIT $ 1,000,000 • C Fiduciary Liabilty PHSD1378579 9/1/2018 9/1/2019 Per Claim Ded 2,500 2,000,000 C Crime Liabilty PHSD1366453 9/1/2018 9/1/2019 Deduct10,000 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: City of Everett Community Development Block Grant The City of Everett, its officers, employees and agents is additional insured as per terms and conditions of the policy per attached formsCG2026 04-13; FM 101.0.2404 11 08 and CG2504 05 09 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 Dept. Planning & Comm. Dev ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore Ave Ste 6-A Everett, WA 98201 AUTHORIZED REPRESENTATIVE j/� Jeff Olsen/MIPARK �-- ( O ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)