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ACORD CERTIFICATE OF LIABILITY INSURANCE 05/24/2016 <br /> PRODUCER rM DATE(MMIDD/YYYY) <br /> Phone:(360)332-7300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Fortiphi Insurance LLC 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 /> I 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 POLICY EXPIRATION LIMITS <br /> LTR INS-D TYPE OF INSURANCE POLICY NUMBER DATE(M POLICY EFFECTIVE DATE IEXPIRAYYI <br /> GENERAL LIABILITY 6012230098 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE D <br /> A Y X COMMERCIAL GENERAL LIABILITY <br /> PREMISES TO <br /> occurence) $ 300,000 <br /> CLAIMS MADE X OCCUR MED EXP(Any one person) $ 10,000 <br /> PERSONAL 8,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 /> 7 POLICY X7 LOC <br /> B Y AUTOMOBILE LIABILITY BAP0004540 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> X ANY AUTO <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> (Per person) <br /> SCHEDULED AUTOS <br /> HIRED AUTOS BODILY INJURY $ <br /> (Per accident) <br /> NON-OWNED AUTOS <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> AUTO ONLY-EA ACCIDENT $ <br /> GARAGE LIABILITY <br /> ANY AUTOOTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> C EXCESS/UMBRELLALIABILITY 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 /> WC STATU- OTH- StopGap <br /> A WORKERS COMPENSATION AND 6012230098 07/01/2015 07/01/2016 E.L.EACH ACCIDENTXER $ 1,000,000 <br /> EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> Y <br /> EXCLUDED?OFFICER/MEMBER E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> SPECIAL PROVISIONS below <br /> OTHER <br /> B Excess Auto UMC0004181 07/01/2015 07/01/2016 2,000,000 <br /> D Professional Liab E0000029495-01 07/01/2015 07/01/2016 Each Claim 2,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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:Sewer M Phase II <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 /> 3101 Cedar Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR <br /> Everett,WA 98201 REPRESENTATIVES. <br /> AUTHOR ED REPRESENT TIVE <br /> ``°_' (SDK) <br /> ©ACORD CORPORATION 1988 <br /> ACORD 25(2001108) Printed by SDK on May 24,2016 at 03:42PM <br />