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4`R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2020 ) <br /> 03/13/2020 <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.If <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this w <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c <br /> PRODUCER CONTACT CD <br /> AOn Risk Services Northeast, Inc. NAME: a <br /> New York NY Office (A/CNNo.Ext):E (866) 283-7122 (aC No): (800) 363-0105 iii <br /> One Liberty Plaza E-MAIL p <br /> 165 Broadway, Suite 3201 ADDRESS. I <br /> New York NY 10006 USA <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 <br /> Seattle SMSA Limited Partnership INSURER B: New Hampshire Insurance Company 23841 <br /> dba Verizon Wireless <br /> 1095 Avenue of the Americas INSURERC• AIU Insurance Company 19399 <br /> New York NY 10036 USA INSURER D: American Home Assurance Co. 19380 <br /> INSURER E. Illinois National Insurance Co 23817 <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:570080889163 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. Limits shown are as requested <br /> INSR ADOL SUBR POLICY EFF POLICY EXP - <br /> LTR TYPE OF INSURANCE INSD WVD_ POLICY NUMBER (MM/DD/YYYY1 MM/DD/YYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY GL6412251 06/30/2019 06/30/2020 EACH OCCURRENCE $7,000,000 <br /> DAMAGE-1O RENTED <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $7,000,000 <br /> X XCU Coverage is Included MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $7,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $7,000,000 m <br /> 03 <br /> X POLICY I ICE° I I LOC PRODUCTS-COMP/OPAGG $7,000,000 <br /> co <br /> OTHER n <br /> A CA 299-19-14 06/30/2019 06/30/2020 COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY $S,OOO,OOO <br /> AOS (Ea accident) „ <br /> A X ANY AUTO CA 299-19-18 06/30/2019 06/30/2020 BODILY INJURY(Per person) 0 <br /> Z <br /> OWNED SCHEDULED MA BODILY INJURY(Per accident) 0) <br /> A AUTOS <br /> AUTOS ONLY CA 299-19-15 06/30/2019 06/30/2020 PROPERTY DAMAGE tQ <br /> HIREDNLYAUTOS UOSNON-OWNEDL VA U <br /> ONLY _AUTOS ONLY (Per accident) <br /> A See Next Page 06/30/2019 06/30/2020 d <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE U <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE <br /> DED RETENTION <br /> B WORKERS COMPENSATION AND WC014649148 06/30/2019 06/30/2020 X PER STATUTE OTH- <br /> EMPLOYERS'LIABILITY Y/N AOS ER <br /> ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT $3,000,000 <br /> D OFFICER/MEMBEREXCLUDED? N N/A WC014649146 06/30/2019 06/30/2020 <br /> (Mandatory in NH) CA E.L.DISEASE-EA EMPLOYEE $3,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $3,000,000— <br /> . <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> RE: Site Name: City of Everett, WA - Small Cell MLA, Location Code: TBD, Site Address: TBD (Multiple). City of Everett, <br /> its officers, officials, agents (excluding City construction contractors and their subcontractors), employees and volunteers <br /> are included as Additional Insured with respect to the General Liability and Automobile Liability policies. ;....: <br /> JP <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> POLICY PROVISIONS. ill <br /> City of Everett AUTHORIZED REPRESENTATIVE <br /> 3200 Cedar Street <br /> Everett WA 98201 USA Or <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />