2020/06/10 Council Agenda Packet

n DATE{MMIDDIYYYY) - ACORD CERTIFICATE OF LIABILITY INSURANCE S DATE /202Y TH�RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 CLC3 PRODUCER NAME: AX PHONE (800)726-8 F 771 I(A/C,No): (e66)72a-9168 Leavitt Group Northwest (A/C,No,Ext): PO Box 65770 E-MAIL E-MAILADDRESS:Broker INSURER(S)AFFORDING COVERAGE NAIL# University Place WA 98464 INSURERA:American Fire & Casualty Company 24066 INSURER B:Ohio Security Insurance Company 24082 INSURED Triangle Associates Inc INSURERc:Underwriters at Lloyds of London 157 92 811 First Ave #255 INSURER D: INSURER E: Seattle WA 98104 INSURERF: COVERAGES CERTIFICATE NUMBER:19/20 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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. LIMITSTR ADDL SUBR POLICY EFF POLICY EXP INSRL TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) 1,000,000 XCOMMERCU\L GENERAL LJABILfTY EACH OCCURRENCE $DAMAGE TO RENTED 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ A X Y s3a553022e2 10/23/2019 10/23/2020 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 3,000,000 X POLICY l I JET LO GEN'LAGGREGATELIMfrAPPL1ESPL PRODUCTS-COMP/OP AGG $ 3,000,000 C $ OTHER: COMBINED SINGLE LIMIT $ 1,000,000 - (Ea accident) AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULEDBA555302282 10/23/2019 10/23/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS DAMAGE $ (Per accident)HIRED AUTOS S NON-OWNED $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE DELI I I RETENTION$ I SER 'ITATUTE X I ORH- $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE I IN/A A (Mandatory WA Stop Gap EL EACH ACCIDENT $ 1,000,ODD OFFICER/MEMBER EXCLUDED? 10/23/2019 10/23/2020 EL DISFJaSE-EA EMPLOYEE $ 1,000,000 atory in NH) HIQ+55302282 yes,If describe under DESCRIPTIONEL DISEASE-POLICY LIMIT $ 1,000,000 OF OPERATIONS below MPL103380519 7/13/2019 7/13/2020 Per Claim/Deductible 1,000,000/5,000 C Professional Liability 500,000 Sexual Abuse/Molestation - tdPL103380519- -- - 7/13/2019 7/13/2020 Aggregatee _ _ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) t City of Everettinamed additional ofinsured with Sub ogationcperoformeCG8810 04.13, Completed Liability on a aOperations per ry Non-Contributory y basisincluding Waiver form CG8583 04.13 CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. Attn: April Hynes 3200 Cedar St AUTHORIZED REPRESENTATIVE Everett, WA 98201 iA�'—14 - PJ zcGilmer/PJGILM I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo a.registered marks of ACORD INS025(201401)