Domestic Violence Services 7/24/2019

DATE(MWOD/YYYY) A�ORO® CERTIFICATE OF LIABILITY INSURANCE loisiaoia 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 Debbie Cook NAME: Leavitt Group Northwest ( c°NNo.Ext): (800)726-8771 ,(AC,No):(866)728-9168 PO Box 65770E-MAIL 'ADDRESS:debbie-cookGleavitt.com INSURER(S)AFFORDING COVERAGE I NAIC k University Place WA 98464 INSURERA:Great American Insurance Company C16691 INSURED INSURER B: Domestic Violence Services of Snohomish County INSURER C: PO Box 7 INSURER D: INSURER E: Everett WA 98206-0007 INSURERF: 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 POUCY EFF POUCY EXP UNITS LTR INSD WVD POLICY NUMBER (MM/DWYYYY) (MWDD/YYYY) X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 I I DAMAGE TO RENTED A CLAIMS-MADE 1 X OCCUR PREMISES(Ea occurrence) $ 100,000 X PAC059525505 10/10/2018 10/10/2019 MEDEXP(Anyoneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POUCY 'e LOC PRODUCTS-COMP/OPAGG $ 2,000,000 _ OTHER: Stop Gap Employee 81 by $ 1,000,000 AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A 1X I ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS CAP59525605 10/10/2018 10/10/2019 BODILY INJURY(Peraccident) $ _ NON-OWNED PROPERTY DAMAGE _ (Per accident) $ HIRED AUTOS AUTOS I Underinsured motorist $ 1,000,000 UMBRELLA LIAB I X I OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 I DED l X I RETENTION$ 10,000 UMB59525705 10/10/2018 10/10/2019 $ WORKERS COMPENSATION 'I PERIOTH- AND EMPLOYERS'LIABILITY I STATUTE i X Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Gap E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) PAC059525505 10/10/2018 10/10/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POUCY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Everett, Its officers, employees and agents are named as an additional insured as per terms and conditions of form CG2026 04 13 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 2930 Wetmore Ave Ste #8A ACCORDANCE WITH THE POLICY PROVISIONS. Everett„ WA 98201 AUTHORIZED REPRESENTATIVE Jeff Olsen/DECOOK • .j /�O ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)