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A ® DATE(MM/DD/YYYY) <br /> CERTIFICATE OF MARINE / ENERGY 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 CONTACT Maria an Stratton <br /> Aon Risk Central Services, Inc. PHOONE FAX <br /> 4220 Duncan Ave., Suite 401 (A/C.No,Ent): (A/C,No): <br /> St. Louis, MO 63110 E-MAILADDRESS:maria.vanstratton aon.com <br /> PRODUCER <br /> CUSTOMER ID#: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Endurance American Ins.CO. 10641 <br /> Ballard Marine Construction, LLC <br /> 727 S 27th Street INSURER B: Nautilus Insurance Company 17370 <br /> Washougal WA 98671 INSURER C: Mitsui Sumitomo Insurance Company of America 20362 <br /> INSURER D: State National Ins.Co.,Inc. 12831 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1163870064 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> C HULL AND MACHINERY Y Y OLM2510340 1/1/2021 1/1/2022 X I PER SCHEDULE ON FILE <br /> I INSURED VALUE S <br /> X COLLISION LIABILITY COLLISION(Ea occurrence) $1,000,000 <br /> TOWERS LIABILITY TOWERS(Ea occurrence) $ <br /> C PROTECTION AND INDEMNITY 1 Y I Y OLM2510340 1/1/2021 1/1/2022 PER CLUB RULES <br /> CREW LIABILITY JONES ACT X EA OCCURRENCE $1,000,000 <br /> PER VESSEL,CSL <br /> X COLLISION LIABILITY COLLISION(Ea occ),CSL $ <br /> I TOWERS(Ea occ),CSL <br /> TOWERS LIABILITY 1 $ <br /> REMOVAL OF WRECK REMOVAL OF WRECK $ <br /> (Ea occurrence) <br /> IN REM $ <br /> i <br /> 1 $ <br /> $ <br /> D ' POLLUTION LIABILITY V-16866-21 1/1/2021 1/1/2022 EA OCCURRENCE $2,000,000 <br /> X OPA 90 $ <br /> X CERCLA $ <br /> X NON-OPA/NON-CERCLA $ <br /> $ <br /> MARITIME EMPLOYERS LIABILITY N/A ANY ONE PERSON $ <br /> ALTERNATE EMPLOYER ANY ONE ACCIDENT $ <br /> INCLUDES CREW EMPS $ <br /> JONES ACT I $ <br /> DEATH ON THE HIGH SEAS I S <br /> IN REM ENDORSEMENT i $ <br /> I <br /> I $ <br /> B Professional Liab CPP2030916-11 1/1/2021 1/1/2022 $5M Occ/Claim $2,000,000 Agg <br /> Pollution Liab $5M Occ/Claim $2,000,000 Agg <br /> 1 S <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE <br /> City of Everertt WITH THE POLICY PROVISIONS. <br /> Attn:Procurement <br /> 3200 Cedar Street,Door#5 <br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE <br /> Page 1 of 2 ©2012-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 31 (2016/03) The ACORD name and logo are registered marks of ACORD <br />