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ACORDTM OF LIABILITY INSURANCE DATE(MM/DDIYYYY) TM 06/21/2016 PRODUCER Phone:(360)332-7300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fortiphi Insurance LLC HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 288 Martin St, Suite 201 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Blaine,WA 98230 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: CNA 20478 Materials Testing and Consulting Inc INSURER B: Mutual of Enumclaw 14761 _ 805 Dupont Street Suite 5 INSURER C: CNA 20443 Bellingham,WA 98225 INSURER D: Admiral Insurance Company I INSURER E: COVERAGES 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,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER DATE IICYMM/DD/YY) POLICY DATE IMMIDDIYYIN LIMITS LTR INSRP TYPE OF INSURANCE GENERAL LIABILITY 6012230098 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO A Y X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ 300,000 CLAIMS MADE i X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000_ GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000_ POLICY X PEO LOC B Y AUTOMOBILE LIABILITY BAP0004540 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT $ 1,000 000 X ANY AUTO (Ea accident) _ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) — PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTOOTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/UMBRELLA LIABILITY 6012230117 07/01/2015 07/01/2016 EACH OCCURRENCE $ 2,000,000 OCCUR X CLAIMS MADE AGGREGATE $ 2,000,000 $ DEDUCTIBLE —$ X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND 6012230098 07/01/2015 07101/2016TORY LIT TSX OTER Stop Gap EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1,000,000 ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER B Excess Auto UMC0004181 07/01/2015 07/01/2016 2,000,000 D Professional Liab E0000029495-01 07/01/2015 07/01/2016 Each Claim 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is Additional Insured as respects to work performed on their behalf by the Named Insured.Blanket additional insured endorsement SB-146932-E applies.Coverage is primary and non-contributory. Per project aggregate is included. Waiver of subrogration included. Project: Hawthorne Elem-City of Everett/11th&Poplar Street,Everett,Wa CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN City of Everett NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 3101 Cedar Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Everett,WA 98201 REPRESENTATIVES. AUTHOR ED REPRESENT T1VE rV.1-,d(4,---' `__ (SDK) ACORD 25(2001/08) ©ACORD CORPORATION 1988 Printed by SDK on June 21,2016 at 01:20PM