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CocoH1 Non Profit Insurance Program CERTIFICATE OF COVERAGE Issue Date: 05/18/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTI FICATE OF COVERAGE DOES NOT CONSTI TUE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTAT IVE OR PRODUCER,AND THE CERT IFICATE HOLDER. 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 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). PRODUCER COMPANIES AFFORDING COVERAGE GENERAL LIABILITY Clear Risk Solutions American Alternative Insurance Corporation, et al. 451 Diamond Drive Ephrata, WA 98823 AUTOMOBILE LIABILITY American Alternative Insurance Corporation, et al. INSURED PROPERTY Cocoon House American Alternative Insurance Corporation, et al. 2929 Pine Street MISCELLANEOUS PROFESSIONAL LIABILITY Everett, WA 98201 Princeton Excess and Surplus Lines Insurance Company COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP DESCRIPTION LIMITS DATE DATE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY N1-A2-RL-0000013-09 06/01/2018 06/01/2020 PER OCCURRENCE $5,000,000 OCCURRENCE FORM PER MEMBER AGGREGATE $10,000,000 INCLUDES STOP GAP PRODUCT-CO MP/OP $5,000,000 PERSONAL&ADV.INJURY $5,000,000 (LIABILITY IS SUBJECT TO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $50,000,000 AUTOMOBILE LIABILITY ANY AUTO N1-A2-RL-0000013.09 06/01/2018 06/01/2020 COMBINED SINGLE LIMIT $5,000,000 (LIABILITY IS SUBJECT TO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE PROPERTY N1-A2-RL-0000013.09 06/01/2018 06/01/2020 ALL RISK PER OCC EXCL EQ&FL $75,000,000 EARTHQUAKE PER OCC EXCLUDED FLOOD PER OCC EXCLUDED (PROPERTY IS SUBJECT TO A$50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE MISCELLANEOUS PROFESSIONAL LIABILITY N1-A3-RL-0000060.09 06/01/2018 06/01/2020 PER CLAIM $1,000,000 (LIABILITY IS SUBJECT TO A $50,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $40,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Regarding funding contract, Everett Human Needs Shelter. City of Everett is named as Additional Insured regarding this contract only and is subject to policy terms, conditions, and exclusions. Additional Insured endorsement is attached. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLI CY PROVISIONS. CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE City of Everett i1i4' . 2930 Wetmore Ave, Suite 10A • . Everett,WA 98201-4067 3389939