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ACORLf CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 08/16/2019 <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 Rhea Marshall <br /> NAME: <br /> Rice Insurance LLC PHONE (360)734-1161 FAX (360)734-1173 <br /> (A/C,No,Ext): (A/C,No): <br /> 1400 Broadway E-MAIL rhear@riceinsurance.com <br /> ADDRESS: <br /> P.O.Box 639 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Bellingham WA 98227INSURERA: American Hallmark <br /> INSURED INSURER B: Crum and Forster Specialty Insurance <br /> GeoTest Services,Inc. INSURER C: <br /> 741 Marine Dr INSURER D: <br /> INSURER E: <br /> Bellingham WA 98225 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CL1931961374 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 POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS <br /> X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $DAMAGO 1,000,000 <br /> CLAIMS-MADE X OCCUR PREM SES(Ea occurrence) $ 300,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A Y Y 44CL604875 04/02/2019 04/02/2020PERSONAL&ADV INJURY $ - <br /> 1,000,000 <br /> GENT.AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 <br /> POLICY X PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED Y Y 44CL604875 04/02/2019 04/02/2020 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 <br /> A EXCESS LIAB CLAIMS-MADE Y 44CL604875 04/02/2019 04/02/2020 AGGREGATE $ 5,000,000 <br /> DED X RETENTION$ 10,000 $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE X ER <br /> Y/N 1,000,000 <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 44CL604875-WA StopGap04/02/2019 04/02/2020 E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? 1,000,000 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under 1000000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , , <br /> Each Occurrence 2,000,000 <br /> Professional and Pollution <br /> B PKC108478 04/02/2019 04/02/2020 Aggregate 2,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Project:Everpark Garage Structural Repairs <br /> Certificate Holder is Additional Insured as respects to attached form A 01/10 for General Liability. Coverage is Primary and Non Contributory and the <br /> Waiver of Subrogation is included in form#MP9767 for General Liability.Completed Operations is included per form B 01/10. Professional/Pollution <br /> Additional Insured form EN0111-0211 is included and the primary and Non contributory/Waiver of Subrogation is form EN0118-0211. Auto Additional <br /> Insured per form#BA2060 04/11 Primary/Non Contributory applies with the Waiver of Subrogation for the Auto Liability. Umbrella is following form.30 <br /> days notice for cancellation,10 days non pay. <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 /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2930 Wetmore Ave.Suite 9E <br /> AUTHORIZED REPRESENTATIVE <br /> Everett WA 98201 r c1 J U 1)E <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />