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<br /> DATE(MM/DD/YYYY)
<br /> ACORD CERTIFICATE OF LIABILITY INSURANCE 12/04/2020
<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 Willis Towers Watson Certificate Center
<br /> NAME:
<br /> Willis Towers Watson Midwest, Inc. PHONE
<br /> c/o 26 Century Blvd (A/C.No,Extl: 1-877-945 7378 FNC No): 1-888 467-2378
<br /> P.O. Box 305191 ADDRESS: certificates@willis.com
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A: Liberty Mutual Fire Insurance Company 23035
<br /> INSURED INSURERS: Ohio Casualty Insurance Company 24074
<br /> HDR Engineering, Inc.
<br /> 1917 South 67th Street INSURER C: Liberty Insurance Corporation 42404
<br /> Omaha, NE 68106 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:W18901922 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> DAMAGE RENTED
<br /> CLAIMS-MADE X OCCUR PREMSESO(Ea occurrence) $ 1,000,000
<br /> A X Contractual Liability MED EXP(Any one person) $ 10,000
<br /> Y Y TB2-641-444950-030 06/01/2020 06/01/2021 PERSONAL&ADVINJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY X TNT- X LOC PRODUCTS-COMP/OPAGG $ 4,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y AS2-641-444950-040 06/01/2020 06/01/2021 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> B
<br /> X EXCESSLIAB CLAIMS-MADE Y Y EUO(21)57919363 06/01/2020 06/01/2021 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 0
<br /> WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED? No N/A Y WA7-64D-444950-010 06/01/2020 06/01/2021 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella/Excess
<br /> Liability on a Primary, Non-contributory basis where required by written contract. Waiver of Subrogation applies on
<br /> General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation where required by written
<br /> contract and as permitted by law. Umbrella/Excess policy is follow form over General Liability, Auto Liability and
<br /> Employers Liability.
<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 /> AUTHORIZED REPRESENTATIVE
<br /> Attn: Mark Sadler
<br /> 3101 Cedar St �t
<br /> • Veldt'
<br /> �
<br /> • {�.w�/Pd
<br /> Everett, WA 98201
<br /> ©1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> SR ID: 20415984 BATCH: 1905554
<br />
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