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___.....—...4, HALE&AL-01 VSANTOSUOSSO
<br /> ACORO' DATE(MM/DD/YYYY)
<br /> 5 CERTIFICATE OF LIABILITY INSURANCE 12/6/2021
<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 /> CONTACT
<br /> PRODUCER NAME:
<br /> Ames&Gough
<br /> 859 Willard Street (NC, Ext):(617)328-6555 FAX
<br /> No(617)328-6888
<br /> Suite 320 E-MAIL
<br /> boston@amesgough.com
<br /> Quincy,MA 02169
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Nautilus Insurance Company A+,XV 17370
<br /> INSURED INSURER B:Liberty Mutual Fire Insurance Co,XV 23035
<br /> Hart Crowser,a division of Haley&Aldrich INSURER C:The First Liberty Insurance Corporation 33588
<br /> 70 Blanchard Road INSURER D:Lexington Insurance Company A,XV 19437
<br /> Burlington,MA 01803
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD wVD IMM/DD/YYYYI IMM/DD/YYYYI 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
<br /> CLAIMS-MADE X OCCUR ECP01521598 1/1/2021 1/1/2022 DAMAGETORENTED 300,000
<br /> X X PREMISES(Ea occurrence) $
<br /> X includes Contractors MED EXP(Any one person) $ 15,000
<br /> X Pollution Liability PERSONAL&ADVINJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> . POLICY X JERf X LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY (Ea OM acccidentSINGLE LIMIT $ 1,000,000
<br /> X ANY AUTO X X AS2-Z11-254100-021 1/1/2021 1/1/2022 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROrPERTYtDAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> $
<br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> C WORKERS COMPENSATION X PER STATUTE OOTH
<br /> AND EMPLOYERS'LIABILITY WC6-Z11-254100-031 1/1/2021 1/1/2022 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ER
<br /> Y X n, N/A E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? 1 000 000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> D Professional Liab 031710867 1/1/2021 1/1/2022 Per Claim 1,000,000
<br /> D 031710867 1/1/2021 1/1/2022 Aggregate 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> If Al box is checked,GL Endorsement Form#BSUM12000117 applies,.unless another additional insured endorsement is attached to this certificate.All
<br /> Coverages are in accordance with the policy terms and conditions.Excess Liability,if listed above,sits in excess of the CGLI,Auto,Employers Liability,
<br /> including Foreign Policy where required by written contract.
<br /> H&A Project Number: P203982-000 Hart Crowser PSA 2021 Project Name: City of Everett On-Call Geotechnical Engineering Services
<br /> City of Everett,and its officers,employees,and agents shall be included as additional insured with respects to General and Auto Liability where required by
<br /> written contract.General Liability and Auto Liability are Primary and Non-contributory as required per written contract. A 30 Day Notice of Cancellation is
<br /> provided in accordance with the policy terms and conditions.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Cityof Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> re —1ta xu' "
<br /> I
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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