2015/05/06 Council Agenda Packet

s AC DATE(MMDD/YYYY) �� • CERTIFICATE OF LIABILITY INSURANCE 4/8/2015 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). PRODUCER Liberty Mutual Insurance NCONT AAMEACT PO Box 188065 PHONE FAX Fairfield, ON 45018 (Arc.No.Ezt): 800-962-7132 (A/C,No): 800-845-3666 E-MAIL CLServiceCenter@LibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: American States Insurance Company 19704 INSURED INSURER B: First National Insurance Co of America 24724 Barney&Worth Inc 1211 SW 5th Ave Ste 2330 INSURERC: Portland OR 97204 INSURER D: INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 24189463 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. IDDLSUBR1 POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE NSR AINSD I WVD I POLICY NUMBER I(MM DD/YYYY) (MM/DD/YYYY)I LIMITS A I COMMERCIAL GENERAL LIABILITY `/ 01C176083610 6/18/2014 6/18/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY I $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 I POLICY PECOT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ B I AUTOMOBILE LIABILITY 01C176083610 6/18/2014 6/18/2015 Eaaacdet)JINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED • AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ ✓ HIRED AUTOS ✓ AUTOS (Per accident) I$ A i UMBRELLALIAB ✓ OCCUR 01SU43037520 6/18/2014 6/18/2015 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB • CLAIMS-MADE AGGREGATE $ 1,000,000 IDED ✓I RETENTION$10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N I STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under a DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCP.IPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 30 Day Notice of Cancellation"10 Day Notice of Cancellation for Cancellation for Non-Payment of Premium City of Everett is Additional Insured if required in a written contract, agreement permit or schedule. Project:Downtown Parking Study,City of Everett Ongoing Operations Coverage applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett c/o Risk Manager Cii Attorne S Office THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2930 Wetmore Ave SyI E 10C y ACCORDANCE WITH THE POLICY PROVISIONS. • Everett WA 98201 AUTHORIZED REPRESENTATIVE % / _ I • Erik Brown 1 1 8 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25.(2014/01) The ACORD name and logo are registered marks of ACORD