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ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> `r...--"--- 11/04/2020
<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 rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Rhea Marshall
<br /> NAME:
<br /> Rice insurance LLC (q)/Q No EHU (360)734-1161 AA No): (360)734-1173
<br /> 1400 Broadway E-MAIL rhear@riceinsurance.com
<br /> ADDRESS:
<br /> P.O.Box 639 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Bellingham WA 98227 INSURERA: American Hallmark Insurance Company of Texas 43494
<br /> INSURED INSURER B: Crum and Forster Specialty Insurance Company 44520
<br /> GeoTest Services,Inc INSURER C: Alaska National Insurance Co
<br /> 741 Marine Dr INSURERD:
<br /> INSURER E:
<br /> Bellingham WA 98225 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL2032672126 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 NOT+MTHSTANDING 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 ADDLSUBR POLICY EFF POLICY EXP
<br /> INSD WVD POLICY NUMBER (MMIDD/YYYY} (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 300,000
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y 44CL604875 04/02/2020 04/02/2021 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X PRO:LOC 0000
<br /> , u OTHER. $ _
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y 44CL604875 04/02/2020 04/02/2021 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED - NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A EXCESS LIAB CLAIMS-MADE Y Y 44CL604875 04/02/2020 04/02/2021 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION ;MUTE EMPLOYERS'LIABILITY STATUTE X ER
<br /> YIN
<br /> A OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 44CL604875-WAStoP Gap 04/02/2020 04/02(2021 EL EACH ACCIDENT $ 1,000,D00
<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'ODD,000
<br /> Each Ocurrence 2,000,000
<br /> Professional and Pollution
<br /> B Y Y PKC109676 D4/02/2020 04/02/2021 Aggregate 2,000,000
<br /> Deductible 10,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is requlred)
<br /> RE:City of Everett-2021-2022 On-call Materials Testing,Everett,WA
<br /> City of Everett,its officers,employees and agents are Additional Insured as respects to attached form 01/10 for General liability Coverage is Primary
<br /> and Non Contributory and the Waiver of Subrogation is included in form#MP9767 for General Liability.Completed Operations is included per form B 01/10.
<br /> Professional/Pollution Additional Insured form EN0111-0211 is included and the primary and Non contributory. Waiver of Subrogation is included within form
<br /> EN0137-0211 Auto Additional Insured per form#BA2060 04/11 Primary/Non Contributory applies with the Waiver of Subrogation for the Auto Liability.
<br /> Umbrella is following form.30 days notice for cancellation,10 days non pay,
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar St.
<br /> AUTHORIZED REPRESENTATIVE
<br /> Everett WA 98201 v U
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<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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