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AC o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°D/YYYY) `.� 3/29/2016 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). CONTACT PRODUCER NAME: Certificate Department Servco Pacific Insurance INC.NN.Extl:206-216-4830 bn c,Na1:206 260 2903 Ste 22pexter Ave. N. E-MAIL o RESS: certdept@servcopacific.com Seattle WA 98109 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:RLI Insurance Company 13056 _ INSURED LANDASS-02 INSURER B:Lloyd's of London Landau Associates, Inc. INSURER C: 130 2nd Avenue South INSURER D: Edmonds WA 98020 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1626053247 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSR WVD POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) A GENERAL LIABILITY Y Y PSB0005053 12/31/2015 12/31/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEMTO RENTED PREMISES(Ea occurrence) $1,000,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY X ' I LOC $ A AUTOMOBILE LIABILITY Y Y PSA0001952 12/31/2015 12/31/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) • A X UMBRELLA LIAB X OCCUR Y Y PSE0002240 12/31/2015 12/31/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION PSW0002924 12/31/2015 12/31/2016 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY I IMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 /M OFFICEREMBER EXCLUDED? N/A - - — (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Professional Liability Y W13431150401 12/31/2015 12/31/2016 Per Claim $5,000,000 Inc.Pollution Liability Aggregate $5,000,000 Deductible $150,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Chaplain Creek Culverts Replacement. City of Everett is included as an Additional Insured on General Liability,Automobile Liability and Umbrella Liability policies. General Liability and Umbrella Liability policies are Primary and Non-Contributory.Waiver Of Subrogation apply to General Liability,Automobile Liability, Umbrella Liability and Professional Liability policies. 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: Edward J. Fisher, PE 3200 Cedar Street AUTHORIZED REPRESENTATIVE Everett,WA 98201 1 I I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD