Specialized Pavement Marking LLC 6/27/2023

�� ® DATE 05/1D5/023) CERTIFICATE OF LIABILITY INSURANCE 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. m If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on _ IP this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). m '7 PRODUCER CONTACT NAME: s. AOn Risk Insurance Services West, Inc. PHONE FAX CU Denver CO Office (NC.No.Fe* (303) 758-7688 (A/C.No.): (303) 758-9458 v 0 1900 16th Street, Suite 1000 E-MAIL = Denver CO 80202 USA ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURERA: The Travel ers Indemnity Co. 25658 Specialized Pavement Marking, LLC INSURER B: Travelers Property Cas Co of America 25674 175 Roy Road SW, Bldg C Pacific WA 98047 USA INSURER C: The Charter Oak Fire Insurance Company 25615 INSURERD: Arch Specialty Insurance Company 21199 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570099417899 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 CONTRACT OR 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, Limits shown are as requested INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y VTC2KCO3K9907061ND23 01/01/2023 01/01/2024 EACH OCCURRENCE $2,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL 8ADV INJURY $2,000,000 m m GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 POLICY X PECOT LOC PRODUCTS-COMP/OP AGG $4,000,000 rn cc OTHER: 0 N B AUTOMOBILE LIABILITY Y Y VTC2J-CAP-3K990718-TIL-23 01/01/2023 01/01/2024 COMBINED SINGLE LIMIT $lr000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) SCHEDULED BODILY INJURY(Per accident) Z OWNED AUTOS UI AUTOS ONLY PROPERTY DAMAGE V X HIRED AUTOS X NON-OWNED (Per accident) ONLY AUTOS ONLY t o D X UMBRELLA LIAB X OCCUR UXP105098900 01/01/2023 01/01/2024 EACH OCCURRENCE $5,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION , c WORKERS COMPENSATION AND UB1W5734672325K 01/01/2023 01/01/2024 X I PER STATUTE I 10TTH. EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $1,000,000 ANY OFFIC(R/MEMBER N NIA EXECUTIVE OFFICER/MEMBER (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 Dy describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Business Auto Physical Damag VTJ-BAP-3K99072A-TIL-23 01/01/2023 01/01/2024 Actual Cash Value Included Coverage a\ .4L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) =i RE: Job/Location/Project: 27308 - 2023 Citywide Pavement Markings: City of Everett, Its Officers, Employees And Agents are 4:fin included as Additional Insured in accordance with the policy provisions of the General Liability, Automobile Liability and Umbrella Liability policies. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Umbrella Liability policies. ▪ 1 CERTIFICATE HOLDER CANCELLATION s� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -_ DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Y_ ▪ - eil .0 City of Everett AUTHORIZED REPRESENTATIVE rye" 2930 Wetmore Ave., Suite 9E _, Everett WA 98201 USA elir Jen Ratfisdatanets '6 4 LYi//�'f Wj �/ ®■ ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD