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Client#:329535 ROTHHIL 3
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE
<br /> TE(MM/2010
<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 /> Kibble&Prentice,a USI Co. PHONE 206 441-6300 FAX 610-362-8528
<br /> (AIC,No,Ext): (A1C,No):
<br /> P.O.Box 370 EMAIL I centre uest k com.com
<br /> ADDRESS: I-'• q P
<br /> Seattle,WA 98111 PRODUCER
<br /> CUSTOMER ID#:
<br /> 206 441-6300 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURERA:Hartford Casualty Insurance Corn 29424
<br /> Roth Hill,LLC INSURER B:U.S.Specialty Insurance Compa 29599
<br /> 11130 NE 33rd Place,Suite 200
<br /> INSURER C Hartford Underwriters Insurance 30104
<br /> Bellevue,WA 98004
<br /> INSURER D:
<br /> INSURER E:
<br /> INSURER F: _
<br /> COVERAGES CERTIFICATE NUMBER: 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 NSR NVD , POLICY NUMBER (MM/DDIYYYY) JMM/DD/YYYY) LIMITS
<br /> A GENERAL LIABILITY 52SBAPM9250 07/12/2010 07/12/2011 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO
<br /> COMMERCIAL GENERAL LIABILITY PREMISES(EaENTED occurrence) $300,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000
<br /> X Business Liability 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 r j T LOC
<br /> C AUTOMOBILE LIABILITY 52UECUS5676 07/12/2010 07/12/2011 COMBINED SINGLE LIMIT $
<br /> (Ea accident) 1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $
<br /> SCHEDULED AUTOS PROPERTY DAMAGE
<br /> X HIRED AUTOS
<br /> (Per accident) $
<br /> X NON-OWNED AUTOS
<br /> $
<br /> •
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DEDUCTIBLE $
<br /> RETENTION $ $
<br /> A WORKERS COMPENSATION 52SBAPM9250 07/12/2010 07/12/2011 TORYLI IT X 2P-
<br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVEYI N (WA Stop Gap) E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<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 /> B Professional USS1020440 05/10/2010 05/10/2011 $2,000,000 per claim
<br /> Liability $2,000,000 annl aggr.
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
<br /> Re:Water Main Improvement Project K.
<br /> As required by written contract the City of Everett,its officers,employees and agents are named as
<br /> (See Attached Descriptions)
<br /> CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn:Richard Hefti, PE
<br /> 3200 Cedar Street AUTHORIZED REPRESENTATIVE
<br /> Everett,WA 98201
<br /> ©1988-2009 ACORD CORPORATION.All rights reserved.
<br /> ACORD_25_(2009/09)__. .1--of 2-- The ACORD name_and logo_are.re istered marksof ACORD_
<br /> #S4881793/M4778546 4 3 MXTJU
<br />
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