Northwest Corrosion Engineering 1/25/2017

A L® CERTIFICATE OF LIABILITY INSURANCE DATE/].o/2am7) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Molly Saben Wycoff Insurance Agency Inc. PHONE Est): (360)336-2112 1/FA No):(360)336-5241 501 South 2nd Street E-MAIL Moll S coffinsurance.com ADDRESS: yy P. 0. Box 1010 INSURER(S)AFFORDING COVERAGE NAIC# Mount Vernon WA 98273 INSURER A:Ohio Security Insurance Co. 24082 INSURED INSURER B:Ohio Casualty Insurance Co. 24074 Northwest Corrosion Engineering, LLC INSURER C:Roust on Casualty Co_ 10995 Warfield Rd INSURERD: INSURER E: Sedro Woolley WA 98284 INSURER F: COVERAGES CERTIFICATE NUMBER:1.7-18 all liab REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - -ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE JpISD WVD POLICY NUMBER I(MMIDD/YYYY} (MM/DD/YYYY)I LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ BKS57099885 1/21/2017 1/21/2018 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L J PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: - LEXE $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BAS57099885 1/21/2017 1/21/2018 BODILY INJURY Per accident) $ AUTOS AUTOS X HIRED AUTOS R NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ X UMBRELLA UAB x 'OCCUR EACH OCCURRENCE — �$ __...... 2,000,000 B EXCESS UAB CLAIMS-MADE AGGREGATE $ 2,000,000 A U8057099885 1/21/2017 1/21/2018 $ I DEDRETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER _......._ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A ----- $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under --_-- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ C PROFESSIONAL LIABILITY HCC1622325 12/15/2016 12/15/2017 EACH CLAIM $2,000,000 CLAIMS MADE AGGREGATE $2,000,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER IS ADDED AS ADDITIONAL INSURED PER ATTACHED FORM CG8810 04/13. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EVERETT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3200 CEDAR STREET ACCORDANCE WITH THE POLICY PROVISIONS. EVERETT, WA 98201 ORI D REPRESENTATIVE / PR �/✓ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)