2014/06/11 Council Agenda Packet

I T RIAA-1 OP ID:ZCDT . oPATE(Id�MIDD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 0 511 5/2 01 4 THI�TIFICATE 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). CONTACT PRODUCER Phone:425-258-2300 NAME: Whitfield's United Insurance Fax:425-258-9363 ram.Ezt1:866-298-0570 I(ac,No):866-688-5709 PO Box 1127/3425 Broadway (AIC.No E-MAIL e(cwhitfie!d 1eavi4t.Com Everett,WA98206 ADDRESS: John Reynolds INSURER(S)AFFORDING COVERAGE I NAIC C INSURER A:Ohio Security Insurance Co 24082 INSURED Triangle Associates Inc INSURER S:Catlin Specialty Insurance Co I15989 811 First Ave#255 INSURER C Seattle,WA 98104 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: - REVISION NUMBER: THIS IS TO TT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEENTO THE INSURED NAMED ABOVE FOR THE NDICATED.CERTIFY NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CO TERACT OR OTHER DOCUMENT WITH RESPECT TOLICY WHICHRIOD 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. 1NSRIIADDLISUBR POLICY POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR I VWD POLICY NUMBER I(MM/DDIYYYY)I(MMIDDIYYYY) GENERALUABIUTY EACH OCCURRENCE I$ 1,000,000 10/23/2013 10/23/2014 DAMAGETORENTED 1,000,000 A X COMMERCIAL GENERAL LIABILITY X BKS55302282 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(My one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 X WA Stop Gap GENERAL AGGREGATE $ 3,000,000 . PRODUCTS-COMP/OP AGG $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- $ X I POLICY JTY I LOG COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ 1'000'000 A _ANY AUTO BAS55302282 10/23/2013 10/23/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ - —AUTOS — AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE I$ EXCESS UAB CLAIMS-MADE AGGREGATE $ I DED I I RETENTION$ $ WORKERS COMPENSATION I WCY LIMITS I v IOT ER ANY EMPLOYERS' A LIABILITY BKS55302282 10/23/2013 10/23/2014 E.L EACH ACCIDENT $ 1,000,000 A ANY OFFICER/MEMBERPROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? Y!N NIA 1,000 000 (Mandatory in NH) WA STOP GAP EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 2,000,000 g Professional Liab SGC0127004 07/19/2013 07/19/2014 Per Claim 1,000,000 Ded 2,500 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is named additional insured with respects to general liabiltiy as per written contract form CG88101009. 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 Attn: Lori Tobin AUTHORIZED REPRESENTATIVE 3200 Cedar St 7 Everett,WA 98201 , ,� _ ��c;, o� I O 1983-20 i0 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo gre registered marks of ACORD