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AC� DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 07/28/2021 <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 /> MARSH USA INC. NAME` <br /> PHONE I FAX <br /> 111 S.W.COLUMBIA (A/C.No.Extl: _ _1(A/C„No): <br /> FIFTH FLOOR EMAIL <br /> PORTLAND,OR 97201 ADDRESS: <br /> Attn:Amy Shafer/amy.shafer@marsh.com/503-248-4857 INSURER(S)AFFORDING COVERAGE NAIC# <br /> CN103018140-SG-FRONT-20-22 INSURER A:Old Republic Insurance Co 24147 <br /> INSURED INSURER B:N/A N/A <br /> SIERRA PACIFIC INDUSTRIES <br /> CORPORATE HEADQUARTERS INSURER C:N/A N/A <br /> PO BOX 496028 INSURER D:Starr Indemnity&Liability Company 38318 <br /> REDDING,CA 96049 — <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: SEA-003757207-01 REVISION NUMBER: 2 <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 W LIMITS <br /> LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI <br /> A X COMMERCIAL GENERAL LIABILITY MWZY31120121 06/01/2021 06/01/2022 EACH OCCURRENCE $ 2,000,000 <br /> DAMAGE <br /> CLAIMS-MADE X OCCUR PREMISESO(EaENTED occur occurrence) $ 2,000,000 <br /> X Loggers BF Prop Dmg MED EXP(Any one person) $ EXCLUDED <br /> X Contractual Liability PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> X POLICY !Jr,: LOC PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> EC <br /> OTHER: $ <br /> MWTB31120021 06/01/2021 06/01/2022 COMBINED SINGLE LIMIT $ 2,000,000 <br /> A AUTOMOBILE LIABILITY (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED X 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 /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> D WORKERS COMPENSATION 1000004380 10/01/2020 10/01/2021 X PER ER LIABILITY STATUTE ER <br /> Excludes CA,WI 1,000,000 <br /> OFFICER/MEMBER EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) Includes(WA,OH)Stop Gap Liability E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> D WASHINGTON STOP GAP COVERAGE 1000004380 10/01/2020 10/01/2021 EACH ACCIDENT 1,000,000 <br /> INCLUDES U.S.L.&H.coverage EACH EMPLOYEE 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> City of Everett,its officers,employees and agents are included as additional insured(except workers compensation)where required by written contract. Sierra Pacific Industries is a qualified set-insurer for <br /> Workers'Compensation coverage in the State of Washington.Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. This insurance is primary and non- <br /> contributory over <br /> any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 3200CedarSt., THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Everett,WA 98201 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />