Snohomish County PUD 6/15/2016 - Laserfiche WebLink

CERTIFICATE OF SELF - INSURANCE Issue Date 5/23/2016 ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Public Utility District No. 1 of Snohomish County AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS PO Box 1107 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY PUBLIC UTILITY Everett, WA 98206 DISTRICT NO. 1 OF SNOHOMISH COUNTY SELF INSURANCE LIABILTY PROGRAM. INSURED: COVERAGE AFFORDED BY: Public Utility District No. 1 Of Snohomish County Public Utility District No.1 of Snohomish County AEGIS Insurance Services PO Box 1107 Everett, WA 98206 PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY IS SELF- INSURED FOR TORT LIABILITY CLAIMS. ALL CLAIMS MUST BE FILED WITH THE PUD'S OFFICE OF RISK MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY REQUIREMENTS. COVERAGES THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT TO ALL THE TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH PROGRAM. POLICY EFFECTIVE EXPIRATION TYPE OF COVERAGE NUMBER DATE DATE LIMITS GENERAL LIABILITY Self- BODILY INJURY,PROPERTY DAMAGE Continuous Continuous Insured &PERSONAL INJURY X GENERAL LIABILITY COMBINED EACH OCCURRENCE $2,000,000 X OCCURRENCE COVERAGE AUTOMOBILE LIABILITY Self-Insured Continuous Continuous BODILY INJURY&PROPERTY DAMAGE X ANY AUTO COMBINED EACH ACCIDENT $2,000,000 X ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS WORKERS COMPENSATION AND Self- STATUTORY EMPLOYERS LIABILITY Insured Continuous Continuous $2,000,000 EACH ACCIDENT FOR BODILY INJURY/ EACH EMPLOYEE FOR BODILY INJURY BY DISEASE BODILY INJURY, PROPERTY DAMAGE&PERSONAL x OTHER-Excess Liability AEGIS Pol# 6/01/2016 6/01/2017 INJURY COMBINED EACH OCCURRENCE XL5113604P $35,000,000 DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES/SPECIAL ITEMS:Coverage applies as respects tort liability claims against Public Utility District No.1 of Snohomish County as covered by the Tort Claims Act(RCW 4.96 et seq.). CERTIFICATE HOLDER: CANCELLATION Mr. Mike Palacios SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, PUBLIC Facilities/ Real Property Director UTILITY DISTRICT NO. 1 OF SNOHOMISH COUNTY WILL MAIL WRITTEN NOTICE City of Everett TO THE CERTIFICATE HOLDER. FAILURE TO MAIL SUCH NOTICE SHALL NOT 2930 Wetmore Ave IMPOSE ANY OBLIGATION OR LIABILITY UPON PUD NO.1 OF SNOHOMISH Everett,WA 98201 COUNTY,ITS AGENTS OR REPRESENTATIVES. Certificate x'261 Permit parking at Norton Avenue Substation AUTHORIZED REPRESENTATIVE: during reconstruction _ L. t V1 / 4 Jan6t Barnes,AR ,Risk Manager