2023/04/05 Council Agenda Packet

Client#: 699461 H2DLLC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 3/17/2023 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services NW PR 601 Union Street, Suite 1000 Seattle, WA 98101 INSURED H2D, LLC 23020 Edmonds Way Unit 113 Edmonds, WA 98020 CONTACT Please See Below NAME: PHONE 206 441.6300 (A/C, Na Exf): E-MAIL ADDRESS Seattl e. P LC a rt Req u est@us i. co m FAX No): 610-362-8530 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Company INSURER B: Hartford Fire Insurance Company 25615 19682 INSURER C : INSURER D : 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 CONTRACTOR 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. - NSR LTRINSR - TYPE OFINSURANCE ADDLSUBR WVD ----_--__-------- POLICY NUMBER POL (MM/DD/YYYY) CYEFF ---_._. POLICYEXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6803W6895392347 01/09/2023 07/01/2023 EACH OCCURRENCE $2,000,000 I CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ 1,000,000 __, _XI MEDEXP(Any one person) $5000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X PRO - JECT LOC PRODUCTS - COMP/OPAGG $4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ___ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) AUTOS ONLY ,_„ AUTOSONLY(Penaccident) Y DAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION X 6803W6895392347 01/09/2023 07/01/2023 STATUTE X ERR- AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE (WA Stop Gap) E.L. EACH ACCIDENT $1,000,000 Rin EXCLUDED? N N/A NH) (Mandatoryfyes,din NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 Iescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 B Professional Liability X 520H046336622 07/01/2022 07/01/2024 $2,000,000 per claim $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Culmback Building Remodel The General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to the City of Everett, its officers, employees and agents only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the named insured. 30 day notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION City of Everett 802 E. Mukilteo Blvd, Suite 100 Everett, WA 98203 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 of 1 #S39419394/M39419096 ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JBLJU