2014/01/22 Council Agenda Packet

4 ACORD TM CERTIFICATE OF LIABILITY INSURANCE Date1R) 0/03/20 3 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 be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER • CONTACT Heffernan Insurance Brokers NAME: 1350 Carlback Avenue (A/O No Exl): 925-934-8500 (ILC Na): 925-934-8278 Walnut Creek,CA 94596 EMAIL CA License#0564249 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER k Hartford Fire Insurance Company 19682 Krazan&Associates,Inc. INSURER B: 215 West Dakota Avenue INSURER C: Clovis,CA 93612 INSURER D: INSURER E: INSURER F: COVERAGES: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 ADDU' SUER POLICY NUMBER POLICY EFF POLICY EXP Lades LTR INSR WVD (MM/DO/YYYY) (MMIODNYYY) GENERAL L LIABILITY EACH OCCURRENCE S 1,000.000 A X COMMERCIAL GENERAL LABILITY X 57UENAM3949 10/01/1310/01/14 DAMAGE TO RENTED PREMISES S„am (Ea occurrence) CLAIMS-MADE n OCCUR MED EXP(My ane person) S 10.000 X Stop Gap PERSONAL&ADV INJURY S 1,000,000 X Oed�ible:SO GENERAL AGGREGATE S 2.000.000 GENT.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2000.000 • POLICY n PROJECT n LOC EMPLOYEE BENEFITS S 1,000,000 AUTOMOBILE UABILITY • COMBINED SINGLE LIMIT S 1J100,000 (Ea accident) A X ANY AUTO X 57UENAM2726 10/01/13 10/01/14 BODILY INJURY(Per person) S ALL OWNED AUTOS SCHEDULED ODDLY INJURY(Per accident) S _ AUTOS HIRED AUTOS NON-OWNED (Per( caPe S AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE— CLAIMS- S EXCESS LIAB AGGREGATE S - MADE _ DED RETENTION S S WORKERS COMPENSATION WC STATU- OTHER AND EMPLOYERS'LIABLRY Y;N TORY LIMITS ANYPROPRIETDIWARTNEWEXECURVFJ EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory N N.H.) E.L DISEASE-EA EMPLOYEE S • If yes.describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POUCY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) Re:As Per Contract or Agreement on File with Insured.City of Everett,its officers,employees and agents are named as additional insured on General Liability policy and additional insured on Automobile Liability policy per attached endorsements.General Liability insurance is primary as included on the policy form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Everett 3101 Cedar Street AUTHORIZEDD REPRESENTATIVE Everett,WA 98201 ACORD 25(2010/05) ©1-8-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD 60