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8 <br /> ACORD® CERTIFICATE OF LIABILITY INSURANCE 4/30/2014' <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). . <br /> PRODUCER CONTACT Sandi Jones <br /> NAME: <br /> Rice Insurance LLC PA/ NoHOC.NE.Extl: (360)734-1161 FAX <br /> (AIC.No):(360)734-1173 <br /> I <br /> 1400 Broadway ADDRIEss:sandi@riceinsurance.com <br /> P.0. Box 639 INSURER(S)AFFORDING COVERAGE NAIC 6 <br /> Bellingham WA 98227 INsuRERA Hartford Casualty 29424 <br /> INSURED INSURERB:HartfOrd Ins Co of Midwest 37478 <br /> GEO TEST SERVICES INC INsuRERc:Alaska National Insurance Co. <br /> 741 MARINE DR INSURERDHuds0n Specialty Insurance <br /> • <br /> INSURER E: <br /> BELLINGHAM WA 98225 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:CL1432522802 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTRINSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PRMTO RENTED PREMDAMAGE GE ISES(Ea occurrence) $ 300,000 <br /> A CLAIMS-MADE X OCCUR X Y 52SBAPS1329 4/2/2014 4/2/2015 MEDEXP(Anyoneperson) $ 10,000 <br /> Wa Stop Gap/Employers PERSONAL&ADVINJURY $ 2,000,000 <br /> GENERAL AGGREGATE $ 4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES� PER: PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> 7 POLICY Fl P78-FI( I LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> • (Ea accident) $ 1,000,000 <br /> B X ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOWNED 'SCHEDULED X 52UECPE6011 4/2/2014 4/2/2015 BODILY INJURY(Peraccident) $ <br /> AUTOS AUTOS _ <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS _ AUTOS (Per accident) $ <br /> • <br /> $ , <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 <br /> A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 <br /> DED X RETENTION$ 10,000 X 52SBAPS1329 4/2/2014 4/2/2015 $ <br /> C WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY ' Y I N X TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE USL&H E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? NIA 13EWU08957 5/4/2013 5/4/2014 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> D Profesional Liability X ES82420161404 4/2/2014 4/2/2015 Limit $2,000,000 <br /> Pollution Liability 4/2/2014 4/2/2015 Limit $2,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Certificate Holder, it's officers, employees and agents are Additional Insured as respects attached form <br /> SS00080405 for General Liability. Coverage is Primary and Non Contributory and the Waiver of Subrogation <br /> is included. Professional/Pollution additional insured form ESB-COM-1108-279 is included and the Waiver <br /> of Subrogation form ESB-COM-1108-228 <br /> CERTIFICATE HOLDER CANCELLATION <br /> jnottingham@everettwa.gov 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 /> John Nottingham PE <br /> 3200 Cedar Street AUTHORIZED REPRESENTATIVE <br /> Everett, WA 98201 n i <br /> 7 • <br /> Troy Haskell/SAN ---"=----N_______ __,-11/4----K, __Q___lee_ <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025t7nlnnRt 01 Tha Ancuzn Hama and Irwin aro ranictarad marlrc of AC.fRfl <br />