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M/DD/
<br /> AcoRD DATE(MMDD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 5/6
<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 /> Dealey, Renton&Associates PHONE FAX
<br /> P. O. Box 12675 IA/c.No.Ext): 510-465-3090 (A/c,No):510-452-2193
<br /> Oakland, CA 94604-2675 ADDRESS: certificates@dealeyrenton.com
<br /> License#0020739 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:National Fire Insurance Co of Hartford 20478
<br /> INSURED PARAINC-01 INSURER B:Continental Insurance Company 35289
<br /> Para1019 9t hx,Ave.IncINSURER C:American Casualty Company of Reading PA 20427
<br /> 1019 39th ve. SE Suite 100
<br /> Puyallup,WA 98374 INSURER D:XL Specialty Insurance Co. 37885
<br /> (253)604-6600 INSURERS:Valley Forge Insurance Company 20508
<br /> INSURER F: Continental Casualty Company 20443
<br /> COVERAGES CERTIFICATE NUMBER:1563831469 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 EFF POLICY EXP/Y LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y 6050531366 11/1/2020 11/1/2021 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000
<br /> X Contractual Liab MED EXP(Any one person) $10,000
<br /> X XCU Included PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X PEf LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> X OTHER: WA Stop Gap/EL WA Stop Gap $1,000,000
<br /> E AUTOMOBILE LIABILITY Y Y 6050531352 11/1/2020 11/1/2021 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 X UMBRELLA LIAB X OCCUR Y Y 6050531433 11/1/2020 11/1/2021 EACH OCCURRENCE $15,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000
<br /> DED X RETENTION$ft $
<br /> C WORKERS COMPENSATION Y 6050531383 11/1/2020 11/1/2021 X STATUTE OTH
<br /> -
<br /> ER WA Stop Gap
<br /> F AND EMPLOYERS'LIABILITY Y/N 6050531402 11/1/2020 11/1/2021
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<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 /> D Professional Liability DPR9967689 11/1/2020 11/1/2021 Per Claim $1,000,000
<br /> Claims Made Annual Aggregate $1,000,000
<br /> Pollution Liability Included Y Retroactive Date: 01/01/1969
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Umbrella Liability policy is a follow-form to underlying General Liability/Auto Liability/Employers Liability.
<br /> Project Name: Everett Water Filtration Plant--
<br /> City of Everett,its officers,employees and agents are named as Additional Insured on General Liability and Auto Liability,per policy forms,with respect to the
<br /> operations of the Named Insured as required by written contract or agreement. General Liability is Primary/Non-Contributory per policy form wording.
<br /> CERTIFICATE HOLDER CANCELLATION 30 Days Notice of 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 /> Attn:Zachary Brown
<br /> 3200 Cedar Street AUTHORIZED REPRESENTATIVE
<br /> Everett WA 98201 31/440.
<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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