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/ 1 ®AC D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 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 PHOO,E Eat): (360)734-1161 jn/c,No). (360)734-1173
<br /> 1400 Broadway E-MAIL rhear@ricelnsurance corn
<br /> ADDRESS
<br /> P O Box 639 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Bellingham WA 98227 INSURER A 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 INSURER D
<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 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMA000
<br /> RENTED
<br /> CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y 44CL604875 04/02/2020 04/02/2021 PERSONAL&ADVINJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> JECT
<br /> 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 PER
<br /> AND EMPLOYERS'LIABILITY STATUTE X ER
<br /> Y/N 1 000,000
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 44CL604875-WA StopGap04/02/2020 04/02/2021 E L EACH ACCIDENT $ ,
<br /> OFFICER/MEMBER EXCLUDED 1,000,000
<br /> (Mandatory in NH) E L DISEASE-EA EMPLOYEE $
<br /> If yes,descnbe under 1000000
<br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ ,
<br /> Each Ocurrence 2,000,000
<br /> Professional and Pollution
<br /> B Y Y PKC109676 04/02/2020 04/02/2021 Aggregate 2,000,000
<br /> Deductible 10,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<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 A 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
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<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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