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DAVICON-01 ACARLSON <br /> ACORO° DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 2/3/2020 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> CONTACT Amy Carlson <br /> PRODUCER NAME: <br /> Basin Pacific Insurance&Benefits <br /> 16400 Southcenter Pkwy,Ste 406 (A/c No,Ext): FAX No): <br /> Tukwila,WA 98188 E-MAIL <br /> -ADDRESS:acarlson@basinpacific.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Developers Surety&Indemnity Company <br /> INSURED INSURER B:Mutual of Enumclaw Insurance Company 14761 <br /> Davis Construction INC INSURER C: <br /> 18 W Marilyn Ave INSURER D: <br /> Everett,WA 98204 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD !MM/DD/YYYYt_1MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR BIS00034170-01 1/11/2020 1/11/2021 DAMAGETORENTED 100,000 <br /> X X PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY jECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: STOP GAP $ 1,000,000 <br /> B AUTOMOBILE LIABILITY (EOMaccBI deen SINGLE LIMIT $ 500,000 <br /> X ANY AUTO BAP000288404 1/9/2020 1/9/2021 BODILY INJURY(Per person) $ <br /> AAUTEO�S ONLY SCHEDULEDy�� BODILY INJURY(Per accident) $ <br /> X AUTOS ONLY X AUUTOS ONLY ((Per acEclatDAMAGE <br /> _ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS <br /> ND EMPLOYERS COMPENSATION <br /> X STATUTE OTH- <br /> ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N BIS00034170-01 1/11/2020 1/11/2021 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N N/A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Bus Shelter Removal and Installation <br /> The City of Everett is additionally insured per attached endorsement:CG2010 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Cityof Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3200 Ceder St <br /> Everett,WA 98201 <br /> AUTHORIZED REPRESENTATIVE <br /> Qw-�Cost�sw�- <br /> I <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />