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A�KI CERTIFICATE OF LIABILITY INSURANCE RATS/H/2019 )
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Stephen Erni
<br /> Arthur J.Gallagher Risk Management Services, Inc. PHONE -. FAX
<br /> (A/
<br /> 777 108th Ave NE, #200 C,No,Ext): 425-454-3386 (A/C,No):425-451-3716
<br /> Bellevue WA 98004 _ADDRESS: Stephen_Erni@ajg.com
<br /> INSURER(S)AFFORDING COVERAGE __ NAIC# _
<br /> INSURER A_Underwriters at Lloyd's London 15792
<br /> INSURED CORPOFT-01 INSURER B:Old Republic Union Insurance Company 31143
<br /> Corporation of the Catholic Archbishop of Seattle
<br /> Catholic Community Services of Western Washington INSURER c:State National Insurance Company,Inc 12831
<br /> 1133 Railroad Ave., Suite 100 INSURER D:
<br /> Bellingham WA 98225 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:995117763 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 /> INSR ADDL SUBR I POLICY EFF POLICY EXP
<br /> LTR - TYPE OF INSURANCE INSD WV!) POLICY NUMBER JMM/DD/YYYY1.JMM/DD LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY I Y BP1023018 7/1/2018 7/1/2019 EACH OCCURRENCE
<br /> $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X J OCCUR i PREMISES(Ea occurrence) $1,000,000
<br /> . MED EXP(Any one person) $Nil
<br /> ■ PERSONAL B ADV INJURY i$1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1,000,000
<br /> X POLICY JECT [ ]LOC
<br /> PRODUCTS-COMP/OP AGG $1,000,000
<br /> OTHER: I $
<br /> A AUTOMOBILE LIABILITY BP1023018 7/1/2018 7/1/2019 (Eo MBcI EDtS SINGLE LIMIT $1,000,000
<br /> X ANY AUTO i l BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURYPer accident
<br /> AUTOS ONLY AUTOS ( ) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY _(Per accident) $
<br /> B UMBRELLA LIAB X OCCUR 821800 0785428 7/1/2018 7/1/2019 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION$ $
<br /> c WORKERS COMPENSATION NDE-0927740-18 7/1/2018 7/1/2019 X PER 2-4-H_AND EMPLOYERS'LIABILITY Y/N _ STATUTE
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBEREXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under - ----
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> I 1
<br /> I 1 I I
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Limits shown are inclusive of defense and insured retention.
<br /> Coverage for Additional Insureds is restricted to the amount of insurance required by contract or permit.
<br /> City of Everett,its officers,employees and agents are included as Additional Assured as required by written contract,agreement,or permit issued to the Named
<br /> Insured.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Everett
<br /> 2930 Wetmore Avenue AUTHORIZED REPRESENTATIVE
<br /> Everett WA 98201
<br /> c, iy
<br /> .,...r
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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