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)® ACCDATE(MM/DD/YYYY) L.....-•--- CERTIFICATE OF LIABILITY INSURANCE 7/30/2019 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(les)must have ADDITIONAL INSURED provisions or 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 (OR)Heffernan Insurance Brokers PHONE FAX 5100 SW Macadam, Suite 440 lac.No.ExtI:503-226-1320 (A/c,No):503-226-1478 Portland OR 97239 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:First National Insurance Company of America 24724 INSURED FORTERR-01 INSURER B:American States Insurance Company _ 19704 901tert Ave.NWINSURER C:Travelers Casualty and Surety Company of America 31194 901 Fifth Av #2200 _ Seattle WA 98164 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:646816902 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 TR TYPE OF INSURANCE ASD L SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS JN (MM/DD/YYYY) (MM/OD/YYYY) A X COMMERCIAL GENERALLIABILITY Y 25CC36185170 7/1/2019 7/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 X WA Stop Gap MED EXP(Any one person) $20,000 $3MM/S1MM/$1MM PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP A GG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y 25CC36185170 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ B UMBRELLA LIAB X OCCUR 01SU43052570 7/1/2019 7/1/2020 EACH OCCURRENCE _ $10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 _ DED X RETENTION$1 n Jinn Prod/ComOps Ag $10,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEM BER EXCLUDED? — (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Professional Liability 105620248 6/9/2019 6/9/2020 Each Claim Limit 1,000,000 Retroactive 6/9/2006 Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re:As Per Contract or Agreement on File with Insured.City of Everett,its officers,employees and agents are included as an additional insured(and primary) on General Liability and Automobile Liability policies per the attached endorsements,if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Cory Rettenmier, Parks and Community Services Manager AUTHORIZED REPRESENTATIVE 802 E. Mukilteo Blvd. Everett,WA 9820341; /,r/ �,- I ��f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD