Work Opportunities 5/20/2019 - Laserfiche WebLink

Aco O® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ki.----- 12/31/2018 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 i CONTACT Tiffan Brewster NAME: y PLC Insurance, LLC IAtCAx PHO No, ExU 24.25)712-3664 1 No):(425)712-17e6 19401 40th Ave W, Suite 440 E-MAIL tiffan lcins.com ADDRESS: y� INSURER(S)AFFORDING COVERAGE NAIC 0 Lynnwood WA 98036 INsuRERABerkshire Hathaway Spec Ins Co _ INSURED I INSURER B Work Opportunities, Inc. INSURERC: 6515 - 202nd St. SW INSURERD: INSURER E: Lynnwood WA 98036-5998 INSURERF: COVERAGES CERTIFICATE NUMBER:19/20 GL & Auto 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 - --- _--- -----ADbLISUBR .- .- POLICY EFF POLICYEXP 1 -- -_ ..__....... LTR 1 TYPE OF INSURANCE INSD'MID POLICY NUMBER IMM/DDlYYYY) IMM!DD/ YYY) LIMITS ' X !COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I I CLAIMS-MADE X OCCUR DAMAGE TO RENTED-- A occurrence) 100,000 PREMISES_Ea occurrence) $. (. 47SP&14849804 ; 1/1/2019 1/1/2020 MEDEXP(Any one person) $ 5,000 , PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X i POLICY JEC LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 I__.. - ;Ea accidenh X ANY AUTO BODILY INJURY(Per person) $ A .__ALL OWNED • SCHEDULED ,__--;AUTOS _. ._. AUTOS 47RWS148499D4 • 1/1/2019 1/1/2020 BODILY INJURY(Per accident) $ NON-OWNED i - 'PROPERTY DAMAGE ---- ___ i HIRED AUTOS AUTOS - $ Per accident) - - Medical payments $ 5,000 UMBRELLA UAB OCCUR I 'EACH OCCURRENCE $ EXCESS UABCLAIMS-MADE, i 1 I 1 AGGREGATE $ i DED RETENTION S - $ Y/NI WA STOP GAP / EMPLOYER'S PER x ,ERH (EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N!A LIABILITY E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ------ - ------- -- ----- ----- A (Mandatory In NH) 47SPR14849004 1/1/2019 1/1/2020 E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT-$ 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RE: Grant Funding City of Everett, its officers, employees and agents are included as an additional insured as required by written contract per attached CG2026 0413. CERTIFICATE HOLDER CANCELLATION rjohnson@everettwa.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2930 Wetmore Avenue Ste. 8A ACCORDANCE WITH THE POLICY PROVISIONS. Everett, WA 98201 AUTHORIZED REPRESENTATIVE Darwin Rieck/TIFFAN r ....-e _ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1NS025 19n14011