Forterra 1/23/2017 - Laserfiche WebLink

DATE(MM/DD/YYYY) ACORI® CERTIFICATE OF LIABILITY INSURANCE 11/17/2016 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 NAME: (OR)Heffernan Insurance Brokers PHONE 503-226-1320 FAX 503-226 1478 5100 SW Macadam, Suite 440 A/C,No.Ext)- (NC.No): Portland OR 97239 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:First National Insurance Company of 124724 INSURED FORTERR-01 INSURER B:America n States Insurance Company 119704 Forterra INSURER C:Travelers Casualty and Surety Compa 131194 901 Fifth Ave.#2200 Seattle WA 98164 INSURER D: INSURER E: INSURER F: _ COVERAGES CERTIFICATE NUMBER: 1022792192 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 TYPE OF INSURANCE IADDLSUBR NSD iPOLICY EFF POLICY EXP WVD POLICY NUMBER (MM/DD/YYl'Y)1.(MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 25CC36185140 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000 X WA Stop Gap$1 MM MED EXP(Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $3,000,000 PRO- JECT OTHER: $ A AUTOMOBILE LIABILITY Y 25CC36185140 7/1/2016 7/1/2017 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO j BODILY INJURY(Per person) $ AUTS OWNED - SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS X- NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ B X UMBRELLA LIAB X OCCUR 01SU43052540 7/1/2016 7/1/2017 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED ��,X RETENTION$10,000 Prod./Comp.Ops.Agg. $10,000,000 WORKERS COMPENSATION SPER TATUTE H ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVENIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Professional Liability 105620248 6/9/2016 6/9/2017 Limit Each Claim 1,000,000 Retroactive 6/9/2006 Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: As Per Contract or Agreement on File with Insured. City of Everett, its officers, employees and agents are included as additional insured (and primary) on General Liability and Automobile Liability policies per the attached endorsements, if required. CERTIFICATEHOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Jeff Price, Everett Parks ACCORDANCE WITH THE POLICY PROVISIONS. and Recreatiion Director 802 E.Mukiteo Blvd. Everett,WA 98203 AUTHORIZED REPRESENTATIVE I � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD