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ACORo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlOD1YYYY)
<br /> 1‘,....---.- 11/28/2016
<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 be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Annie Santorelli.
<br /> NAME:
<br /> Degginger McIntosh and Associates PHO No.ExD; (425)740-5200 lntc,Nol:(425)740-5201
<br /> WC.PO Box 1400 ADDRE SS:Annie@dmainsurance.com
<br /> ADDRESS:
<br /> 3977 Harbour Point Blvd SW INSURER(S)AFFORDING COVERAGE _ NAICE
<br /> Mukilteo WA 98275 INSURER AOhio Security Insurance Co
<br /> INSURED INSURER B Ohi.0 Casualty Ins Co
<br /> Bush, Roed 6 Hitchings, Inc. INSURERCAXIS Insurance Company
<br /> 2009 Minor Ave E INSURER D:
<br /> INSURER E:
<br /> Seattle WA 98102 INSURER,:
<br /> COVERAGES CERTIFICATE NUMBER:16-17 GL/BA/SG/UM/PL REVISION NUMBER:
<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 /> USSR I ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR t TYPE OF INSURANCE INSO WVD POLICY NUMBER IMWDD/YYYYI (MM/DDrYYYY) LIMITS
<br /> i X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ,$ 1,000,000
<br /> DAMAGE TO RENED
<br /> A CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 1,000,000
<br /> X CONTRACTUAL LIABILITY X Y BKS55823498 12/5/2016 12/5/2017 MED EXP(Any one person) $ 15,000
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X I Tel: I I LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED
<br /> AUTOS AUTOS X y 6)1555823498 12/5/2016 12/5/2017 BODILY INJURY(Per accident)~
<br /> — NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS i (Per accident)
<br /> $
<br /> X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED ! X RETENT/ONS 10,000 X Y 0505582349$ 12/5/2016 12/5/2017 PER10TH. $
<br /> NOII X 4M9>$F? ICKC 1( STATUTE x ER
<br /> JJXQ(EMPLOYERS'LIABILITY Y(N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 1 N(A WA STOP- GAP E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER(MandatorynH)EXCLUDED? BTCS55823498 12/512016 12/5/2017 E1.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> A In NH)
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 2,000,000
<br /> C PROFESSIONAL LIABILITY AEA000308-02-2016 12/5/2016 ' 12/5/2017 EACH CLAIM $2,000,000
<br /> AGGREGATE $2,000,000
<br /> I
<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 is included as Additional Insured per attached form CG8810(0413) with respect to any and
<br /> all operations of the Named Insured. Coverage is Primary and Non-Contributry and includes a Waiver of
<br /> Subrogation per same form, a Per Project Aggregate per attached form CG8870(1208) and Completed
<br /> Operations per attached form CG8583(0413) • Additional Insured on the Auto Liability applies per attached
<br /> form CA8810 (0110) . Cancellation applies per attached form IL0146 (0810) . Additional Insured on Umbrella
<br /> Liability applies per attached form CU6002(0697) , coverage includes a Waiver of Subrogation per attached
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> sbridge@everettwa.gov
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 3200 Cedar Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett, WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> L David Tyner, III/AN Z2 7--4;12G04,"-;:: "--7
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
<br /> INS02512014011
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