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<br /> A © CERTIFICATE OF LIABILITY INSURANCE 109/14/2011
<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 LIC #0437153 1-212-948-1306 CONTACT
<br /> •
<br /> NAME:
<br /> Marsh Risk & Insurance Services PHONE I FAX
<br /> fA/CIRTS coin Supportlinternal-j acobs.coNo,Ext): (ANC,No):
<br /> E-MAIL
<br /> 777 S. Figueroa Street ADDRESS:
<br /> PRODUCER - .
<br /> Los Angeles, CA 90017-5822 CUSTOMER ID#:
<br /> Fax to: 1-212-948-1306 INSURER(S)AFFORDING COVERAGE .NAIC#
<br /> INSURED INSURER A: ACE AMER INS CO 22667
<br /> Jacobs Engineering Group Inc. INSURER B:
<br /> 1111 South Arroyo Parkway INSURER C:
<br /> P.O. Box 7084 INSURERD:
<br /> Pasadena, CA 91109-7084 •
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 23060908 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 TYPE OF INSURANCE AINSR,SWVD, POLICY NUMBER JMM//DDUBR /WYY)_MMEFF L
<br /> ICYEXP
<br /> LTR DO//YYYY) LIMITS
<br /> A GENERALLIABILITY HDO G25529030 07/01/11 07/01/12 EACHOCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 250,000
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000
<br /> X CONTRACTUAL LIABILITY PERSONAL&ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000
<br /> POLICY I I ECT LOC • $
<br /> A AUTOMOBILE LIABILITY ISA 1808635651 07/01/11 07/01/12 COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED AUTOS BODILY INJURY(Per accident) $
<br /> SCHEDULED AUTOS PROPERTY DAMAGE $
<br /> HIRED AUTOS (Per accident)
<br /> NON-OWNED AUTOS
<br /> $
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> _ DEDUCTIBLE $
<br /> •
<br /> RETENTION $ $
<br /> A LIMIT
<br /> WORKERS COMPENSATION WCU C46479968 (LA, OH, Tk)+07/01/11 07/01/12 XI WCTORYSTATU-S log-AND EMPLOYERS'LIABILITY WLR C46479920 (AOS) 07/01/11 07/01/12 E.L.EACH ACCIDENT $ 1,000,000
<br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE N N N/A
<br /> A (Mandatory
<br /> EXCLUDED7 SCF C46479944 (ME, WI) 07/01/11 07/01/12 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A PROFESSIONAL LIABILITY EON G21655065 003 07/01/11 07/01/12 PER CLAIM/PER 1,000,000
<br /> "CLAIMS MADE" - AGGREGATE 1,000,000
<br /> DEFENSE INCLUDED •
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> OFFICE LOCATION: Bellevue, WA 98004. PROJECT MGR: Dennis Demuth. SENIOR CONTRACT MGR: Glenn R. Young. RE: Sewer "M"
<br /> Project, UP 3470 - Sewer System Replacement & Capacity Improvements. CONTRACT END DATE: 09/01/2014. SECTOR: Public.
<br /> *$2,000,000 SIR FOR STATES OF: LA, OH, TX. The City of Everett, its officers, employees and agents are added as an
<br /> additional insured for general liability & auto liability as respects the negligence of the insured in the performance
<br /> of insured's services to cert holder under contract for captioned work. Coverage is primary and certificate holder's
<br /> insurance is excess and non-contributory. *THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF
<br /> INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Avenue
<br /> AUTHORIZED REPRESENTATIVE
<br /> Everett, WA 98201 a„..4 0j,/$. .__,
<br /> USA
<br /> I
<br /> nyumdo newgalexy • ©1988-2009 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2009/09) The ACORD name and logo29 registered marks of ACORD
<br /> 23060908
<br />
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