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A C�® DATE(MM/DD/YYYY)
<br /> � CERTIFICATE OF LIABILITY INSURANCE 08/22/2019
<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 Anne Cutting
<br /> NAME:
<br /> HENTSCHELL&ASSOC INC (AHCNN Ext): (253)272-1151 {n/c,No): (253)272-1225
<br /> 1436 S.Union Ave. E-MAIL annec@hentschell.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Tacoma WA 98405-1925INSURERA: Ohio Security Insurance Co. 24082
<br /> INSUREDINSURER B: American Fire and Casualty Co. 24066
<br /> T.E.Walrath Trucking,Inc. INSURER c: Ohio Casualty Insurance Co. 24074
<br /> 11405 24th Ave East INSURER D: Hallmark Specialty Insurance Company
<br /> INSURER E:
<br /> Tacoma WA 98445 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 18-19 GL,AUTO,UMB 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 SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,DAMAGE T000
<br /> RENTED
<br /> CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 300,000
<br /> MED EXP(Any one person) $ 15,000
<br /> A BKS 57585870 11/19/2018 11/19/2019 PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X TROT LOC 00 00
<br /> $ 20,
<br /> .
<br /> OTHER: Employee Benefits $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED BAA1954242791 11/19/2018 11/19/2019 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident) -
<br /> Uninsured motorist $ 1,000,000
<br /> UMBRELLA LIAB vv"'�""-RR"yC,''' • 2,000,000
<br /> X X OCCUR EACH OCCURRENCE $
<br /> C EXCESS LIABCLAIMS-MADE USO 57585870 11/19/2018 11/19/2019 AGGREGATE $ 2,000,000
<br /> DED RETENTION $ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N 1,000,000
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE NIA BKS 57585870 11/19/2018 11/19/2019 E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 10 ,
<br /> 00000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ,
<br /> Excess Liability
<br /> D 77HX184FAB 11/19/2018 11/19/2019 Each Occurrence 3,000,000
<br /> Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett is additional insured re:access to 4000 Railway Ave.Everett,WA per forms CG8810 04 13 and AC8501 06 18.Waiver of subrogation applies
<br /> per form CG8810 04 13,AC8501 06 18 and CU6495 12 07.
<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 EverettAttn:Darcie Byrd ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Facilities/Real Property Direc
<br /> AUTHORIZED REPRESENTATIVE
<br /> 3200 Cedar Street
<br /> Everett WA 98201 Cly
<br /> I
<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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