2013/05/01 Council Agenda Packet

I Q — DAHCORP-01 NFININ A.C.C,RGE CERTIFICATE OF LIABILITY INSURANCE D 12/17/2012 ATE ) 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 NAME: Costello&Sons Insurance Brokers,Inc. PHONE 415 257-2100 FAX 415 455-1516 1752 Lincoln Avenue (AIC,No,Ext):( ) (A/c,No):( ) San Rafael,CA 94901 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A National Fire and Marine Insurance Company INSURED INSURER B:Valley Forge Insurance Company DAH Corporation DBA ISOutsource INSURER C:Lloyd's of London 19119 North Creek Parkway#200 INSURER D: Bothell,WA 98011 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSR WM/ VD POLICY NUMBER (MDD/YYYY) (MM/DD/YYW) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X B5088073228 9/19/2012 9/19/2013 DAMAGE TO(Ea REN I ED nce) $ 300,000 PREMISES occurre CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ---X7POLICY JEC LOC STOP GAP $ 1,000,000 AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT 1,000,000 (Ea accident) A ANY AUTO B5088073228 9/19/2012 9/19/2013 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X HIJTOS AUTOS REDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS UAB CLAIMS-MADE B5088073262 9/19/2012 9/19/2013 AGGREGATE $ DED X RETENTION$ 10,000 Aggregate $• 5,000,000 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N • TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ C Technology E&O • ESB01035378 9/19/2012 9/19/2013 Limit/Agg 3,000,000 • DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of Everett,its officers,employees and agents are included as additional insureds but only as respects liability arising out of operations of the named insured and as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn:IT Director 2930 Wetmore Avenue,Suite GA Everett,WA 98201 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and loge registered marks of ACORD