Automatic Door & Gate 7/26/2021 - Laserfiche WebLink

ACCIRE) DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/16/2021 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). PRODUCER - CONTACT Tara Singer NAME: g Leavitt Group Northwest fA/C No.ExU: (800)726-8771 FAX NO): Ie66)728-916e PO Box 65770 E-MAIL tara-singer@leavitt.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# University Place WA 98464 INSURER A:Ohio Security Insurance Company 24082 INSURED INSURER B:Travelers 19046 Automatic Door & Gate Company INsuRERc:National Union Fire Insurance Company 19445 4014 134th St. NE INSURERD: Attn: Jerry Bayha INSURERE: Marysville WA 98271 INSURER F: COVERAGES CERTIFICATE NUMBER:21/22 PKG Auto EX WC 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 LTRINSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE X OCCUR PREMISES(Ea occurrrrence) $ 1,000,000 X BRS57172837 6/22/2021 6/22/2022 MED EXP(Any one person) $ 15,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BA3S6628532142 6/22/2021 6/22/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS (Per accident) Medical payments $ 5,000 UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 EBU012669505 6/22/2021 6/22/2022 $ WORKERS COMPENSATION PER X OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Gap E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) BRS57172837 6/22/2021 6/22/2022 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project Name: City of Everett. Job Description: South Precinct West Gate Rebuild. City of Everett is named as Additional Insured per written contract and the terms and conditions of forms CG8810 0413 and CG2503 0509 attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 3200 Cedar St. ACCORDANCE WITH THE POLICY PROVISIONS. Everett, WA 98201-4516 AUTHORIZED REPRESENTATIVE Jeff Olsen/TASING •►j /() ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)