|
Client#:326377 PERTEINC
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)7/13/2016
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> USI Kibble&Prentice PR PHONE
<br /> (A/c,No,Ext):206 441-6300 FAx FAXNo?: 610-362-852
<br /> 601 Union Street,Suite 1000 ADpRess: PL.CertRequest@usi.biz
<br /> Seattle,WA 98101 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Travelers Indemnity Company of 25682
<br /> INSURED INSURER B:Travelers Casualty and Surety C 31194
<br /> Perteet, Inc. INSURER C:Phoenix Insurance Company 25623
<br /> P.O.Box 1186
<br /> Everett,WA 98206-1186 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ADDLSUBR
<br /> LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 6809A973147 06/27/2016 06/27/2017 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO a occur ence) $1
<br /> CLAIMS-MADE X OCCUR PREMISES ,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X J COT LOC PRODUCTS-COMP/OP AGG_$2,000,000
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY BA9A974666 06/27/2016 06/27/2017 Ea aBadeD SINGLE LIMIT $1,000,000 —
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> ROPERTY
<br /> X HIRED AUTOS X AO OWNED (Pers cidentDAMAGE
<br /> )
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION 6809A973147 06/27/2016 06/27/2017 STATUTE X ORTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N (WA Stop Gap) E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Professional 106321064 06/27/2016 06/27/2017 $2,000,000 per claim
<br /> Liability $2,000,000 annl aggr.
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: Project#20130279, Everett Downtown Streetscape Improvements-Hoyt Ave.from Pacific Ave.to Wall
<br /> St.,Phase 2-Final Design.
<br /> The General Liability policy includes an automatic Additional Insured endorsement that provides Additional
<br /> Insured status to the Certificate Holder,only when there is a written contract that requires such status,
<br /> and only with regard to work performed on behalf of the named insured.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn: Ryan Sass ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE
<br /> "` jt-
<br /> _
<br /> ©1988-2014 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S18243814/M18008808 KKUZP
<br />
|