Laserfiche WebLink
�l J <br /> Accwic, CERTIFICATE OF LIABILITY INSURANCE DATE 8/7/2014/DDmrY) <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 <br /> NAME: Michael J Hall&Company <br /> Michael J Hall&Company (AHC.Nr o.Exn:360-598-3700 (A/C.Nor <br /> Hall&Company E-MAIL <br /> 19660 10th Ave NE ADDREss:certificates@hallandcompany.com <br /> Poulsbo WA 98370 INSURER(S)AFFORDING COVERAGE I NAIC# <br /> INSURER A:HARTFORD CAS INS CO b9424 <br /> INSURED 4 INSURER B:TRAVELERS CAS&SURETY CO OF AMER 131194 <br /> Gray&Osborne Inc INSURERC: <br /> 701 Dexter Avenue N#200 INSURER D: <br /> Seattle WA 98109 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:591068288 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 I TYPE OF INSURANCE IA SR DM SWVD I POLICY NUMBER I(MM/DDY/YYYY) (MM/DD//YY EXP <br /> I LIMITS <br /> A GENERAL LIABILITY 52SBADU7303 :/10/2013 e/10/2014 EACH OCCURRENCE $1,000,000 <br /> DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISESO(Ea occcu RENTED <br /> $300,000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) I$10,000 <br /> X OCP/XCU/BFPD PERSONAL&ADV INJURY I$1,000,000 <br /> X Separation lnsds GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> POLICY X JEei I I LOC I $ <br /> A AUTOMOBILE LIABILITY 52UECJS3276 9/10/2013 /10/2014 COMBINED SINGLE LIMIT <br /> (Ea accident) $1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS • <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS (Per accident) <br /> $ <br /> A X UMBRELLA UAB X OCCUR 52SBADU7303 9/10/2013 3/10/2014 EACH OCCURRENCE $1,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 <br /> DED I X I RETENTION$10,000 $ <br /> A WORKERS COMPENSATION 52SBADU7303 /10/2013 /10/2014 I WCSTATU- X IOTH- WASto Ga <br /> AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER P P <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) EL.DISEASE-EAEMPLOYEE $1,000,000 <br /> if yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I$1,000,000 <br /> B Professional Liab:Claims Made 105339819 9/10/2013 3/10/2014 $1,000,000 Per Claim <br /> Pollution Liab:Occurrence Form $1,000,000 Aggregate <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Certificate Holder(s)is/are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or <br /> agreement regarding activities by or on behalf of the Named Insured.The Commercial General Liability insurance is primary insurance and <br /> any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance.A waiver of <br /> subrogation applies to the Commercial General Liability,Auto Liability, Umbrella/Excess Liability and Workers Compensation/Employers <br /> Liability in favor of the Additional Insured. <br /> Re:Lake Chaplain Dam Tunnel Decommissioning <br /> CERTIFICATE HOLDER CANCELLATION <br /> 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 /> 3200 Cedar Street <br /> Everett WA 98201 AUTHORIZED REPRESENTATIVE <br /> - � <br /> 01988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD <br /> 20 <br />