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355636
<br /> A ® DATE /YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 2/1/2017
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTNAME: Bradley Bradley Cunic
<br /> Commercial Lines-(412)765-3510 PHONE 412 2274680 FAX 877 808-2136
<br /> (AIC,No,Ext): ( ) (AIC,No): ( )
<br /> Wells Fargo Insurance Services USA,Inc. E-MAIL Cunicdl
<br /> rae wesfar
<br /> ADDRESS: By llo.com @ g
<br /> Four Gateway Center,444 Liberty Avenue,Suite 1500
<br /> INSURER(S)AFFORDING COVERAGE NAIC p
<br /> Pittsburgh, PA 15222-1233 INSURERA: Travelers Property Casualty Co of America 25674
<br /> INSURED INSURER B: Travelers Casualty and Surety Co.of America 31194
<br /> Midwest Communications Technologies, Inc.
<br /> INSURER C:
<br /> D/B/A Black Box Network Services
<br /> INSURER D:
<br /> 255 Enterprise Drive
<br /> INSURER E: _
<br /> Lewis Center,OH 43035 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 11382107 REVISION NUMBER: See below
<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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY)
<br /> A COMMERCIALGENERALLIABILITY X HC2J-GLSA-158D4275-TIL-16 03/31/2016 03/31/2017 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X I OCCUR PRSRENTED
<br /> PREMISES(TOEaaoccurrence) $ 1,000,000
<br /> (
<br /> X CONTRACTUAL LIAB MED EXP(Any one person) $ 10,000
<br /> X 1 $10M AGG PERSONAL&ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,000
<br /> 7— PRO-
<br /> POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY TJ-CAP-131J2340-TIL- 03/31/2016 03/31/2017 COMBINED SINGLE LIMIT $ 2,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS _
<br /> x HIRED x NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY _ AUTOS ONLY (Per accident) ,
<br /> $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A ANDWORKMPL EMPLOYERS'LIAILI TC2JUB-131J222-3-16 03/31/2016 03/31/2017 STATUTE EERH
<br /> LIABILITY
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N TC2JUB-131J222-3-6 03/31/2016 03/31/2017 E.L.EACH ACCIDENT $ 1,000,000
<br /> A OFFICER/MEMBEREXCLUDED? N NIA
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Excess D&O 105763216 03/31/2016 03/31/2017 $5,000,000 for all Claims
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett,and its officers,employees and agents are named as additional insured as it relates to general liability in accordance with the terms and
<br /> conditions of the policy. Umbrella follows form as it relates to additional insureds.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn:Jeanette Postma ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 2930 Wetmore Ave,Suite 6A
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE
<br /> 9(44101"..-
<br /> I
<br /> « ,.�I
<br /> The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103)
<br />
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