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ACCPREP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1)
<br /> 1/4/2021
<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
<br /> NAME: Sally Wallace
<br /> AssuredPartners I Hall&Company PHONE FAX
<br /> 19660 10th Ave NE (A/C,No,Ext):360-598-5028 (MC,No):360-598-5028
<br /> IL
<br /> Poulsbo WA 98370 ADDRESS: sally.wallace@assuredpartners.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Hartford Accident and Indemnity Company 22357
<br /> INSURED 23109 INSURER B:Admiral Insurance Company 24856
<br /> Floyd Snider Inc
<br /> 601 Union St#600 INSURER C:
<br /> Seattle WA 98101 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:632575260 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 INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI
<br /> B X COMMERCIAL GENERAL LIABILITY FEIECC2666501 9/19/2020 9/19/2021 EACH OCCURRENCE $2,000,000
<br /> AMAGE TO
<br /> CLAIMS-MADE X OCCUR PREM PREMISES(EaENTED occurrence) $300,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> X POLICY JET LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABIUTY 52UECGZ3893 9/19/2020 9/19/2021 COMBINED SINGLE LIMIT $1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> B UMBRELLA UAB X OCCUR FEIEXS2666601 9/19/2020 9/19/2021 EACH OCCURRENCE $5,000,000
<br /> X EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000 _
<br /> DED X RETENTION$in nnn Prod/Comp Ops $5,000,000
<br /> g WORKERS COMPENSATION FEIECC2666501 9/19/2020 9/19/2021 PER
<br /> X ER WA STOP GAP _
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBEREXCLUDED? ' I 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 /> B Professional Liab;Claims Made FEIECC2666501 9/19/2020 9/19/2021 Per Claim $1,000,000
<br /> Pollution Liability;Occurrence Aggregate $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Certificate Holder(s)is/are an Additional Insured on the Commercial General Liability,Pollution Liability and Auto Liability when required by written contract or
<br /> agreement regarding activities by or on behalf of the Named Insured.This insurance is primary insurance and any other insurance maintained by the Additional
<br /> Insured shall be excess only and non-contributing with this insurance.A waiver of subrogation applies to the Commercial General Liability,Auto Liability,
<br /> Umbrella/Excess Liability and Employers Liability in favor of the Additional Insured
<br /> the City of Everett,its officers,employees,and agents.
<br /> Project:City of Everett On-Call Environmental Consulting
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Everett
<br /> 3200 Cedar Street AUTHORIZEDREPRE$ENTATIVE
<br /> Everett WA 98201 n
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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