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4GURDM CERTIFICATE OF LIABILITY INSURANCE06/01/2004` • <br /> ) <br /> )DUCER Serial# 61138 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ACIG INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> .12222 MERIT DRIVE,SUITE 1660 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> DALLAS,TX 75251-0000 <br /> (972)702-9004 INSURERS AFFORDING COVERAGE NAIC# <br /> URED INSURER A: AMERICAN CONTRACTORS INS.CO.RRG 12300 <br /> HOFFMAN CONST. CO. OF WASHINGTON INSURER B: ACIG INSURANCE COMPANY 19984 <br /> 805 S.W. BROADWAY,SUITE 2100 INSURER C: NATIONAL UNION FIRE INS CO OF PA 19445 <br /> PORTLAND, OREGON 97205 INSURER D: PEERLESS INSURANCE COMPANY 24198 <br /> l INSURER E: <br /> rVERAGES <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 POLICES 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 /> t ADDTPOLICY EFFECTIVE POLICY EXPIRATION <br /> 2 NSRD1 TYPE OF INSURANCE POLICY NUMBER DATE IMM/DDMQ DATE(MM/DD/YY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ ' 2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY GD04014009 06/01/04 06/01/05 DDAMAGET{EaEoc urDence) $ 100,000 <br /> CLAIMS MADE n OCCUR MED EXP (Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 2,000,000 <br /> _. GENERAL AGGREGATE $ 4,000,000 <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> —I POLICY nJE 7 n LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> BE1647735 06/01/04 06/01/05 <br /> OCCUR n CLAIMS MADE AGGREGATE $ 2,000,000 <br /> $ _ <br /> DEDUCTIBLE $ <br /> RETENTION $ . <br /> WORKER'S COMPENSATION AND W D04014029(ALL OTHER STATES 06/01/04 06/01/05 X TORY L MI S OER <br /> EMPLOYERS'LIABILITY W R04014011(OR) 06/01/04 06/01/05 EL EACH ACCIDENT $ 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? 706-173-00(WA SELFINSURANCE) 06/01/04 06/01/05 EL DISEASE-EA EMPLOYEE $ 1,000,000 <br /> . If y ,describe under <br /> SPEC AL PROVISIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 <br /> OTHER IM9738182 06/01/04 06/01/05 <br /> I CONTRACTORS <br /> EQUIPMENT <br /> SCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> JERETT WWTP <br /> 1E CITY OF EVERETT, BROWN AND CALDWELL AND THEIR OFFICERS,ANY ELECTED OFFICIALS, EMPLOYEES,AGENTS AND <br /> DLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS FOR THIS PROJECT. <br /> ERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL XIXLXXXX.XN MAIL 45 DAYS WRITTEN <br /> CITY OF EVERETT <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,: ' <br /> C/O RISK MANAGER,CITY ATTORNEY'S OFFICE <br /> 2930 WESTMORE AVE.,SUITE 10C '" "'''' "' '• "'' ` '''' ' <br /> EVERETT,WA 98201 • <br /> AUTHORIZED REPRESENTATIVE ARTEX INSURANCE AGENCY,INC. <br /> I MICHAEL J.O'NEILL <br /> :ORD 25(2001/08) ©ACORD CORPORATION 1988 <br /> 11 <br />