|
SeniSSC66
<br /> �� � ( £ i Esq'� i�
<br /> [k®nS t€�7 E[!I}d EIE&QE
<br /> ;" IpA ; no I .: a$
<br /> 3 , - 4rr
<br /> 3 44r7 art xa E Etr11,11 ,ietAl, •
<br /> - 3 � € ffi �a � 4A‘'.10, 41; ry dj
<br /> k l �d61I I11 kEF,' E1t7 q a ate- 05/18/2018
<br /> m , E •_
<br /> .�..., .
<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 COVii4G
<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 /> <, [' bHM+ M h �kiH44471,8'4'
<br /> COVERAGES h � ,„ <, ,z. , . 47,7 ,E.n�• ..7 .,�n �„ .F�,� N, „3, ., , - „ n„�n� 7,
<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 SH OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> 4784 t w 444x,:88 • N= 3 44144
<br /> •� (, ® a • � e s LIMITS
<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) NNUAL POOL AGGREGATE $50,000,000
<br /> AUTOMBIL fi �x"A
<br /> �9. £i%s'i4WYixwKa 'ffi �E
<br /> �tGki1K&9tdi �akcSww47digi843 i!kF9ad�llk€fiEai
<br /> lkmfkmA48E
<br /> Kk 18
<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 /> =344441
<br /> NYS&3 443 t 1 kp4,t 443444 44 P9 E8 4'4^1 :44488MGs 18,4 E 3044 444 VA HP§t 4 p 11184•l44L4h1&Y tt,6,77 11474*i 444434444411444”
<br /> PROPERawa��r�re'>�-�,_ .mar.,..,T�..sa��;•�x:��--ma..�, ....._ ,t ., �. � a.,•�:m.���ssx� r,a E k,.. .,. .• 7..Ek, x a»n�k,w,��t�«m-�,, . k. k_n .>r.,atm=a.�a� sk.m� ��.nw,�,
<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 /> v a Ks,il.__: -:!xU@&5�Eh x49843484 44 LE ..-36LxNa 4x1 87 465E E4�48E,&}CL.' s
<br /> PROFEPROFESSIONALLIA ,�, 4 ',x„
<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)M w ANNUAL POOL AGGREGATE $40,000,000
<br /> •,. .: . t Q i •��:r ::.
<br /> Regarding Community Development Block Grant. City of Everett, its officers,employees,and agents are named as
<br /> Additional Insureds regarding this grant 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 /> 2,10:vmmz• .w 4 re 4d44 411434 `leiNr'm'
<br /> CERTIFICATE HOLD ,e ,AttimAIXED REPRESENTATIVE
<br /> City of Everett ,
<br /> 2930 Wetmore Ave
<br /> Everett,WA 98201
<br /> 3401115
<br />
|