|
,____..•....41 REECTRU-01 AMICHEL
<br /> ACo- CERTIFICATE OF LIABILITY INSURANCE DA2/17/2022 Y)
<br /> �
<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 /> Hub International Northwest LLC PHONE 425 489-4500 FAx 425 485-8489
<br /> PO Box 3018 (NC,No,Ext):( ) (NC,No):(
<br /> Bothell,WA 98041 ADI REss:now.info@hubinternational.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:BITCO General Insurance Corporation 20095
<br /> INSURED INSURER B:Sirius Specialty Insurance Corporation 16820
<br /> Reece Construction Company INSURERC:
<br /> P.O.Box 1531 INSURERD:
<br /> Marysville,WA 98270
<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 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 NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD (MM/DD/YYYYI (MM/DD/YYYYI 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
<br /> CLAIMS-MADE X OCCUR X X CLP3705743 5/10/2021 5/10/2022 DAMAGE TO RENTED 100,000
<br /> PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X 3E8, LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: WA STOP GAP $ 1,000,000
<br /> A AUTOMOBILE LIABILITY (Ea OMBI acgtlentSINGLE LIMIT $ 1,000,000
<br /> X ANY AUTO X X CAP3705741 5/10/2021 5/10/2022 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY accident)
<br /> DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X CUP2821408 5/10/2021 5/10/2022 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> A WORKERS COMPENSATION STATUTEPER X OTRH-
<br /> ANDEMPLOYERS'LIABILITY Y/N CLP3705743 5/10/2021 5/10/2022 1,000,000
<br /> ANY
<br /> OFFICER/MEMBER EXCLUDED?ECUTIVE N/A E.L.EACH ACCIDENT $
<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 E.L.DISEASE-POLICY LIMIT $
<br /> B Pollution Liab.. x x CPLS00017171 5/10/2021 5/10/2022 Limit 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:Project#UT3774,2022 Tulalip Water Pipeline Mortar Repair
<br /> City of Everett Public Works is included as an additional insured,Coverage is Primary and non-contributory and Waiver of Subrogation applies per the
<br /> attached forms/endorsements.Per Project Aggregate applies to General Liability policy,per attached forms/endorsements.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Everett Public Works ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<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
<br />
|