Burton Construction Inc. 10/14/2021

w —..,s BURTCON-04 KDIEHL ACORO DATE(MM/DD/YYYY) �.. CERTIFICATE OF LIABILITY INSURANCE 9/2/2021 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 have ADDITIONAL INSURED provisions or 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). CONTACT Kris Diehl PRODUCER NAME: Hub International Northwest LLC PO Box 3144 (A/CONNo,Ext):(509)319-2908 I FAX No): Spokane,WA 99220 E-MAIL Kris.Diehl@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Phoenix Insurance Company 25623 INSURED INSURER B:Charter Oak Fire Insurance Company 25615 Burton Construction,Inc. INSURER C:Travelers Property Casualty Company of America 25674 3915 E Nebraska INSURER D: Spokane 99217 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI (MM/DD/YYYYI 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR X X DTCO5J58662APHX21 7/7/2021 7/7/2022 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ X $2,500 PD Deductible MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PE X L. PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. WA STOP GAP $ 1,000,000 B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO _ 8102N5323762126G 7/7/2021 7/7/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTYtDAMAGE $ _ AUTOS ONLY _ AUTOS ONLY C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CUP9H8825192126 7/7/2021 7/7/2022 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION STATUTEPER OOER TH AND EMPLOYERS'LIABILITY ,f/N ANYAp PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ (Mandatory$in NHj EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) AS RESPECTS CITY OF EVERETT JOC,CONTRACT#2021-022 ADDITIONAL INSURED STATUS INCLUDING WAIVER OF SUBROGATION IS GRANTED AS IT RELATES TO GENERAL LIABILITY IN ACCORDANCE WITH TERMS AND CONDITIONS OF THE POLICY TO CITY OF EVERETT PER THE ACTUAL FORMS ATTACHED TO THIS CERTIFICATE.UMBRELLA FOLLOWS FORM AS IT RELATES TO ADDITIONAL INSUREDS.THE ABOVE COVERAGE IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EVERETT ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: THERESA BAUCCIO-TESCHLOG 3200 CEDAR STREET EVERETT,WA 98201 AUTHORIZED REPRESENTATIVE TH,/d tom[ 1 I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD