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k • Client#:181600 FIDAPAVI
<br /> 'ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)9/16/2020
<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.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on
<br /> this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER NAMEACT Trisha Thompson
<br /> Propel Insurance (p/C,"o,E,t),800 499-0933 FAX 866 577-1326
<br /> Seattle Commercial Insurance E-MAIL (A/c,No):
<br /> ADDREss: Trisha.Thompson@propelinsurance.com
<br /> 601 Union Street,Suite 3400 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Seattle,WA 98101-1371 INSURER A:Ohio Security Insurance Company 24082
<br /> INSURED INSURER B:The Ohio Casualty Insurance Company 24074
<br /> Fidalgo Paving &Construction LLC INSURER C:Westchester Surplus Lines Insurance Co. 10172
<br /> 16825 Forty Five Road
<br /> INSURER D:
<br /> Arlington, WA 98223
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY BKS55466662 03/15/2020 03/15/2021 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR PREMISESO(Ea occur ence) $I,000,000
<br /> X PD Ded:$250 MED EXP(Any one person) $15,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO- 1
<br /> POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER:
<br /> A AUTOMOBILE LIABILITY BAS5546666 03/15/2020 03/15/2021 raEiccl yeDntISINGLE LIMIT $1,000,000
<br /> XI ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED I-- SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> B X UMBRELLA LIAB X OCCUR US055466662 03/15/2020 03/15/2021 EACH OCCURRENCE $3,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000
<br /> DED X RETENTION$10,000 $
<br /> A WORKERS COMPENSATION BKS55466662 03/15/2020 03/15/2021 I STATUTE $ 0-
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WA Stop Gap E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Leased/Rented EQ BKS55466662 03/15/2020 03/15/2021 $100,0000
<br /> C Pollution G2838841 A001 08/19/2020 08/19/2021 $1,000,000/$2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE:GARFIELD PARK PATH OVERLAY AND SPORT COURT SEAL COAT-2300 WALNUT STREET, EVERETT,WA 98201
<br /> City of Everett is named additional insured per the attached endorsement(s).
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 3200 Cedar Street, Door#5 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett, WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S4273132/M4245493 JMT00
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