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ACD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> k.------- 10/11/2016
<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
<br /> NAME:
<br /> Hub International Northwest LLC
<br /> PHONEFAX
<br /> 110 Unity Street E-MAIL O.EXt):360-647-9000 (arc,No):360-734-8496
<br /> Bellingham WA 98225 ADDREss:NOW.Unitylnfo@hubinternational.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Charter Oak Fire Insurance Company 25615
<br /> INSURED PACISUR-01 INSURER B:The Travelers Indemnity Company 25658
<br /> Pacific Surveying&Engineering Services Inc INSURER C:Admiral Insurance Company 24856
<br /> 1812 Cornwall Ave INSURER D:
<br /> Bellingham WA 98225
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:88823680 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 /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> TYPE OF INSURANCE
<br /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> A GENERAL LIABILITY Y Y 6806H640562 10/19/2016 10/19/2017 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> X
<br /> COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $1,000,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
<br /> 7 POLICY PE°T X LOC $
<br /> B AUTOMOBILE LIABILITY Y Y BA222MA4753 10/19/2016 10/19/2017 COMBINED SINGLE LIMI f
<br /> (Ea accident) $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> , AUTOS _ AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS _ AUTOS (Per accident)
<br /> $
<br /> B X UMBRELLA LIAB X OCCUR Y Y CUP223M177A 10/19/2016 10/19/2017 EACH OCCURRENCE $3,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000
<br /> DED X RETENTION$10,000 $
<br /> A WORKERS COMPENSATION 6806H640562 10/19/2016 10/19/2017 WC STATU- X OTH- St
<br /> o
<br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER P Gap
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE I I NIA E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C Professional Liability E000003534301 10/19/2016 10/19/2017 Per Claim Limit 2,000,000
<br /> Aggregate Limit 2,000,000
<br /> Retention 25,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> Per policy forms and conditions: Blanket Additional Insured(Architects, Engineers and Surveyors)form CG D3 81 09 15;Architects,
<br /> Engineers and Surveyors Xtend Endorsement form CG D3 79 01 16 which includes Per Project Aggregate Limit;and Auto Blanket Additional
<br /> Insured and Waiver per form CA T4 20 02 15.
<br /> RE:All Operations. The Certificate holder, its elected officials, employees and agent are included.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 3200 Cedar St ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> I a/44
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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