Forterra NW 12/16/2020 - Laserfiche WebLink

® DATE(MMldD/YYYY) ACC)REP CERTIFICATE OF LIABILITY INSURANCE 11/30/2020 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: (OR)Heffernan Insurance Brokers PHONE 503-226-1320 FAX v,No):503-226-1478 5100 SW Macadam Ave., Suite 440 (A/C.No.Ext}: E-MAIL Portland OR 97239 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Casualty and Surety Company of America 31194 INSURED FORTERR-01 INSURER B:West American Insurance Company 44393 Forterra NW 901 Fifth Ave.#2200 INSURER C:Ohio Casualty Insurance Company 24074 Seattle WA 98164 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1958873632 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM!DDIYYYY YYY) (MM/DDIY ) B X COMMERCIAL GENERAL LIABILITY Y BKW60991405 7/1/2020 4/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISES0(Ea occurrence) $1,000,000 X WA Stop Gap MED EXP(Any one person) $20,000 $2M1$1M/$1M PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: B AUTOMOBILE LIABILITY Y BKW60991405 7/1/2020 4/1/2021 COMBINEDaaccident) SINGLE LIMIT $1,000,000 (E ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY $ C UMBRELLA LIAB X OCCUR UU060991405 7/1/2020 4/1/2021 EACH OCCURRENCE $10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$in nM $ WORKERS COMPENSATION R OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability 105620248 6/9/2020 4/1/2021 Each Claim Limit $1,000,000 Retroactive 6/9/2006 Deductible $5,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:As Per Contract or Agreement on File with Insured.City of Everett,its officers,employees and agents are included as an additional insured(and primary) on General Liability and Automobile Liability policies per the attached endorsements,if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Cory Rettenmier and Community Services Manager AUTHORIZED REPRESENTATIVE 802 E. Mukilteo Blvd. Z------ Everett,WA 98203 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD