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4 <br /> ACORD,„ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 05/24/2016 <br /> PRODUCER Phone:(360)332-7300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Fortiphi Insurance LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> p HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 288 Martin St, Suite 201 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Blaine,WA 98230 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: CNA _ 20478 <br /> Materials Testing and Consulting Inc INSURER B: Mutual of Enumclaw 14761 <br /> 805 Dupont Street Suite 5 INSURER C: CNA 20443 <br /> Bellingham,WA 98225 INSURER D: Admiral Insurance Company <br /> 1 INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADD'L ' POLICY EFFECTIVE 1 POLICY EXPIRATION <br /> POLICY NUMBER <br /> LTR INS-D TYPE OF INSURANCE DATE(MM/DD/YY) I DATE IMM/DD/YY) LIMITS <br /> GENERAL LIABILITY 6012230098 ! 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE RENE <br /> A Y X COMMERCIAL GENERAL LIABILITY 1 PREM SESO(Ea occurence) $ 300,000 <br /> CLAIMS MADE X OCCUR MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY X j r LOC <br /> B Y AUTOMOBILE LIABILITY BAP0004540 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT <br /> X ANY AUTO (Ea accident) $ 1,000,00 <br /> 0 <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO ' OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> C EXCESS/UMBRELLA LIABILITY 6012230117 07/01/2015 ' 07/01/2016 EACH OCCURRENCE $ 2,000,000 <br /> OCCUR X CLAIMS MADE AGGREGATE $ 2,000,000 <br /> $ <br /> DEDUCTIBLE $ <br /> X RETENTION $ 10,000 $ <br /> A WORKERS COMPENSATION AND 6012230098 07/01/2015 07/01/2016 TU- <br /> TORY LWC IMITSX OETR Stop Gap <br /> EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 1/ E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> OTHER <br /> B Excess Auto UMC0004181 07/01/2015 07/01/2016 I 2,000,000 <br /> D Professional Liab E0000029495-01 07/01/2015 07/01/2016 Each Claim 2,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> Certificate holder is Additional Insured as respects to work performed on their behalf by the Named Insured. Blanket <br /> additional insured endorsement SB-146932-E applies.Coverage is primary and non-contributory. Per project aggregate is <br /> included. Waiver of subrogration included. Project: Kasch Park Soccer Fields Location: 8811 Airport Road, Everett,WA <br /> 98204 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN <br /> City of Everett NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> 802 E Mukilteo Blvd. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> Everett,WA 98203 REPRESENTATIVES. <br /> AUTHOR ED REPRESEENT�TIVE <br /> 1 c 7 �^ (SDK) <br /> ACORD 25(2001/08) ©ACORD CORPORATION 1988 <br /> Printed by SDK on May 24,2016 at 10:44AM <br />