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�-- ® .1 2 DATE(MM/DD/YYYY) Is
<br /> ACORD CERTIFICATE OF LIABILITY INSURANCE 9/13/2016
<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 /> CONTACT Carol Danell
<br /> PRODUCER NAME:
<br /> PHONE (425)712-3664 IAAX No):(425)712-3766
<br /> PLC Insurance, LLC (AIC.No.Ext):
<br /> 4211 Alderwood Mall Blvd, #210 E-MAIL carold@plcins.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Lynnwood WA 98036 INSURERA:Scottsdale Insurance Company
<br /> INSURED INsuRERB:National Union Fire Ins. Co. 02351
<br /> Casne Engineering, Inc. INSURER c New Hampshire Insurance Company
<br /> 10604 NE 38th Place INSURERD:
<br /> Suite 205 INSURERE:
<br /> Kirkland WA 98033 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:15-16 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 /> INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR TYPE OF INSURANCE Inc) WVD POLICY NUMBER JMM/DDlYYYY)JMM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 100,000
<br /> A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $
<br /> BCS0033499 10/29/2015 10/29/2016 MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER:
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT
<br /> PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> $
<br /> OTHER: COMBINED SINGLE LIMIT
<br /> AUTOMOBILE LIABILITY (Ea accident) $Incl in GL Lim
<br /> BODILY INJURY(Per person) $
<br /> A ANY AUTO — —
<br /> ALL OWNED SCHEDULED BCS0033499 10/29/2015 10/29/2016 BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS PROPERTY DAMAGE
<br /> X HIRED AUTOS X NON-OWNED AUTOS (Per accident) $
<br /> $
<br /> UMBRELLA L1AB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> ,,B x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 0 BE026059739 10/29/2015 10/29/2016 $
<br /> NOX XXXIMAXX STATUTE X OTRH-
<br /> X (EMPLOYERS'LIABILITY Y/N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> A (Mandatory in NH) BCS0033499 10/29/2015 10/29/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under Stop Gap E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> C Professional Liability 06499062100 10/29/2015 10/29/2016 Per Claim 3,000,000
<br /> Ded. $25,000; Cla1mq Made Annual Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re: Three Lakes Pressure Sustaining Valve, 161-098
<br /> City of Everett, its officers, employees and agents are added as Additional Insured as required by
<br /> written contract per attached CG2033 0413. Coverage is Primary and Non-Contributory per attached CG2001
<br /> 0413.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett, WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> •
<br /> .. „Dike Rucker/CAROLD ' --, —
<br /> ;54 ©1988-2014 ACORD CORPORATION. All rights reserved.
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