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DATE(MM/DD/YYYY)
<br /> ACC)RE) CERTIFICATE OF LIABILITY INSURANCE 10/29/2021
<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 1-314-721-5100 CONTACT
<br /> NAME:
<br /> Aon Risk Services Central, Inc. PHONE FAX
<br /> (A/C.No.Ext): (NC,No):
<br /> E-MAIL
<br /> 4220 Duncan Avenue ADDRESS:
<br /> Suite 401 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> St Louis, MO 63110 INSURERA: GREAT AMER ALLIANCE INS CO 26832
<br /> INSURED INSURER B: Markel Intl. Ins. Co. Ltd
<br /> Ballard Marine Construction, LLC g INSURER C: Amer. Lon shore Mutual Assn.
<br /> 727 S. 27th Street INSURERD:
<br /> INSURER E:
<br /> Washougal, WA 98671 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 63666258 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 'ADDLISUBR ' POLICY EFF POLICY EXP
<br /> LTR ll TYPE OF INSURANCE INSD 1 WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> 'COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE $
<br /> ' DAMAGE O RENTED
<br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $
<br /> PERSONAL&ADV INJURY $
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $
<br /> PRO- I1
<br /> POLICY JECT I LOC 1 PRODUCTS-COMP/OP AGG $
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br /> (Ea accident)
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> I
<br /> OWNED I SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED I PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident) _
<br /> I I $
<br /> UMBRELLA LIAB OCCUR 1 EACH OCCURRENCE $
<br /> I EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A i WORKERS COMPENSATION WC218323104 01/01/21 01/01/22 X PER
<br /> STATUTE OTH-
<br /> ER AND EMPLOYERS'LIABILITY
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N N N/A I E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $
<br /> B ;Maritime Emp. Liab. i B200620-024-21 01/01/21 01/01/22 CSL 1,000,000
<br /> I
<br /> C 'Federal USL&H Act I ALMA01081-07 01/01/21 01/01/22 Limits as Above 1,000,000
<br /> 1
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Carrier E: Markel International Ins. Co. Ltd. ; Statutory coverage in the following jurisdictions: AZ, CA, FL & NV
<br /> USL&H jurisdictions states are: AL, AR, CA, CO, FL, GA, IL, IN, LA, MD, MI, MN, MS, NC, NH, NV, NY, OK, SD, TN, TX,
<br /> VA, WA, WI, WV; MEL/Jones Act territorial limits of the Continental USA or its outer continental shelf, Alaska, Hawai,
<br /> Canada or Puerto Rico or as may be agreed by underwriters.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Procurement
<br /> 3200 Cedar Street AUTHORIZED REPRESENTATIVE
<br /> Door #5 /}
<br /> Everett, WA 98201 . _,,.,u J0
<br /> I USA ( 6f� ���lYYffk��
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> cody.daech@aon.com
<br /> 63666258
<br />
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