Triangle Associates Inc. 6/16/2020

® DATE(M M/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 5/12/2020 THIS CERTIFICATE 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 CLC3 PRODUCER NAME: Leavitt GroupNorthwest PHONE (800)726-8771 FAx AIC,NO (866)728-9168 (A/C.No,Ext): ( ): E-MAIL Broker PO Box 65770 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# University Place WA 98464 INSURERA:American Fire & Casualty Company 24066 INSURED INSURERB:Ohio Security Insurance Company 24082 Triangle Associates Inc INsuRERc:Underwriters at Lloyds of London 15792 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. ADDL SUBR POLICY EFF POLICY EXP INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 A CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ X Y BKA55302282 10/23/2019 10/23/2020 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO I JECT L LOC PRODUCTS-COMP/OPAGG $ 3,000,000 $ OTHER: AUTOMOBILE LIABILITY (Ee CMBINED accident)SINGLE LIMIT $ 1,000,000 BODILY INJURY(Per person) $ B _ ANY AUTO ALL OVVNED SCHEDULED BAS55302282 10/23/2019 10/23/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER X OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Gap E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N IA E.L.DISEASE-EA EMPLOYEE $ 1,000,000 A (Mandatory in NH) 5KA55302282 10/23/2019 10/23/2020 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability MPL103380519 7/13/2019 7/13/2020 Per Claim/Deductible 1,000,000/5,000 Sexual Abuse/Molestation MPL103380519 7/13/2019 7/13/2020 Aggregatee 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City of Everett is named additional insured with respect to General Liability on a Primary Non-Contributory basis including Waiver of Subrogation per form CG8810 04.13, Completed Operations per form CG8583 04.13 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: April Hynes 3200 Cedar St AUTHORIZED REPRESENTATIVE Everett, WA 98201 � (/n�� PJ zcGilmer/PJGILM , J o' "'- ,,,_ 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(zo14o1)