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ACORD CERTIFICATE OF LIABILITY INSURANCE t LI 01/20/2005Y)• <br /> DDUCER Serial# 100190 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 /> cJ DALLAS,TX 75251-0000 <br /> (972)702-9004 INSURERS AFFORDING COVERAGE NAIC# <br /> URED - INSURER A: AMERICAN INTERNATIONAL SPECIALTY 26883 <br /> HOFFMAN CONSTRUCTION COMPANY OF INSURER B: <br /> WASHINGTON <br /> 805 S.W. BROADWAY,SUITE 2100 INSURER C: <br /> PORTLAND,OREGON 97205 INSURER D: <br /> I INSURER E: <br /> )VERAGES <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 /> R ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> R NSRD DATE(MM/DD/YY) DATE(MM/DD/YY) <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> — <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> PREMISES (Ea occurence) $ <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ <br /> PERSONALE.ADV INJURY $ <br /> GENERAL AGGREGATE _$ <br /> GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG $ <br /> POLICY n JECT 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 /> $ <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG S <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> 1 OCCUR n CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ •- • <br /> WORKER'S COMPENSATION AND XOR STATU- OTH- <br /> EMPLOYERS'LIABILITY TORY LIMITS ER <br /> EL EACH ACCIDENT <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> $ <br /> OFFICER/MEMBER EXCLUDED? <br /> EL DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ <br /> OTHER CPO 6191864 06/01/02 06/01/05 EACH OCCURRENCE $5,000,000 <br /> CONTRACTORS POLLUTION AGGREGATE $10,000,000 <br /> LIABILITY <br /> SCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> VERETT WWTP <br /> HE CITY OF EVERETT, BROWN AND CALDWELL AND THEIR OFFICERS,ANY ELECTED OFFICIALS, EMPLOYEES,AGENTS AND <br /> OLUNTEERS 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 XXXXXXXX MAIL 45 DAYS WRITTEN <br /> CITY OF EVERETT <br /> C/O RISK MANAGER, CITY ATTORNEY'S OFFICE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, a a• •c <br /> 2930 WESTMORE AVE.,SUITE 10C ''' " "' ""' •'" `� ' <br /> EVERETT,WA 98201 ' <br /> AUTHORIZED REPRESENTATIVE ARTEX INSURANCE AGENCY,INC. <br /> CORD 25(2001108) ©ACORD CORPORATION 1988 <br /> r- ' 17 <br />