|
^•f
<br /> 17
<br /> A CERTIFICATE OF LIABILITY INSURANCE phre I --
<br /> �,r,�• �� 09!066!/00fYYYr)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 femis and conditions of the policy,certain policies may require an endorsement. A statement on this certificate door not confer rights to the
<br /> certificate holder in lieu of such endorsemont(s}.
<br /> PRODUCER Phone (330)898-3700 Fax.(360)898.3103 , cmn•ACT MICHAEL J.HALL&COMPANY
<br /> MICHAEL J.HALL&COMPANY MONO r> 360)598-37.00_ ; (360)598-3703
<br /> HALL&COMPANY t__....:...:.$).. Sw_-- �__._,r..._..._..---.....
<br /> EasAu.
<br /> 19660 10TH AVENUE N.E. OPORZSO.__ .__._..._.. __ _...,_._.........._.._.._...__�___.. _._.. __ .....__.
<br /> PRODUNIR
<br /> POULSBO WA 98370 yucror_(ntrtrP�•`�
<br /> INSURER(S)AFFORDING COVERAGE NAICg
<br /> I rne° C:^URLRh Travelers Casualty and Surety Co of America 31194
<br /> GRAY&OSBORNE INC
<br /> 701 DEXTER AVENUE N11200 RNSURER0 Hartford Casualty Insurance Co. 29424
<br /> •
<br /> SEATTLE WA 98109 INSURERG
<br /> INSURER 0:
<br /> INSURER IF -
<br /> _ *MEER F •
<br /> COVERAGES CERTIFICATE NUMBER: 144869 ��—�•Y. REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI.ICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHIC(i THIS
<br /> CERTIFICATE' MAY BE ISSUED OR MAY PERTAIN, •r•5 INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
<br /> EXGLUSIONS.AND CONDITIONS OF 3QCrli POLICIESJ,MITS SHOWN MAY HAVE BEEN REDSLCED BY PAID CLAIMS.
<br /> (NSR 8001.SUM POLICY EFF POLICY exP
<br /> Lrrt_ TYPE OP INSURANCE OMR JAW.•_,._,-•••__ POLICY NUMBER _lLps70aA'YYY Ilam_ YYY LIMITS
<br /> GENERhi. LIABILITY •}--�••�+•_ p>Y---)•-•--••-,.•_,_„ _
<br /> B _...__...._._. ._ 52SBADU7303 09/10/11 09110/12 EACH OccuRRENCE s 1,000,000
<br /> X COMMERCIALGENERAI,LIABILITY ontslegTORfNYED •""'—'"'
<br /> P�GLUs;^E,(,eaoccutencr�_,--_,,,,,, S 300,000
<br /> Ct.AtMS•MADE X'OCCUR _
<br /> MED EXI>(Any oat/person) $ - 10,000
<br /> X OCP.XCU,BFPO PERSONAL&ADV INJURY $ _-- 1,000,000
<br /> • X SeparaSofl of Insureds
<br /> GENERALAGGIiEGATB $ 2,000,000
<br /> GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMP/OP AGG S 2,000,000
<br /> IfoucY P.M. .__..._�_._...._....»_.._.._..._..__�_�_......._...
<br /> XkGI. !Loc_-- s
<br /> •
<br /> 13 AUTOMOBILE IJAeIGrr 1 62UECJS3276 09/10/11 09/10/12 LIMIT
<br /> X ANY AUTO (Ea ac $
<br /> 1ti000W000
<br /> _
<br /> ALL OWNED AUT05 OOptIYINJURY(Per persai) 5
<br /> -•--• BODILY INJURY(Per acedont) $
<br /> SCHEDULED AUTOS PItOPGRi'Y DAMAGE
<br /> X HIRED AUTOS r(Per acadenl) S
<br /> X NON-OWNED AUTOS
<br /> B uMnReu.ln LIAO X 52S13ADU7303 - 09_10/12
<br /> •••, O('.CtIR 09/10111 09/10/12 EAClioGGUE?RENEE
<br /> EXCESS LIAR i AGGREGATE _...._._.. .$--•.-...
<br /> Ctlat$-MACE1,000,000
<br /> __._.
<br /> ,,,•_, DEDUCTIBLE
<br /> X RETENTION $ 10,000
<br /> B WORKERS COOPERS/MOM 52SI3ADU7303 09/10/11 09/10/12
<br /> fr?
<br /> j. .IWStop Ga3,ANO EMPLOYERS' AIIY Y
<br /> ANY PROPIEIETORIRIEXEOUTIUS (- • EI.EACH ACCIDENT s 1,000,000
<br /> oErtcEnaopnrR eXCLUOE07 I
<br /> Nil, ••--•----_......._...._....._._.__...__„.»._....---
<br /> (amatory
<br /> —.—..__-
<br /> (a w,tory to Ntq """"' F..L DISEASE,EA EMPLOYEE S 1,000,000
<br /> OESCRIPTION OP OPERATIONS below E.L.DISEASE•POUCY UNIT s 1,000,000
<br /> A Professional L4abIIy-Claian Made Font 105339819 09/10/11 09/10/12 $1,000,000 Per Claim
<br /> $1,000,000 Aggregate
<br /> .._.....___�._......___._.._._.__.._...._.__.._._,..__._._._.__.___..-._..__.. ._.________..__. _____.I.........__..___..__......._�___._._._.___....._..... ---....__.._..--
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORO tot,Addflonal Remarks Schedule,it more space Is required)
<br /> SEE SUPPLEMENTAL CERTIFICATE INFORMATION
<br /> •
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City Of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE wrrrH THE POLICY PROVISIONS.
<br /> 2930 Wetmore
<br /> Everett,WA 98201 --•----.•__._._..__._.__ . ..___.
<br /> AUTINORiXP.p REPRESEttrArrvE
<br /> Attention: f 5•
<br /> L/G /Ashley L.Hurd
<br /> ACORD 25(2009/09) CO 1988-2009 ACORD CORPORATION. All rights reserved. •
<br /> The ACORD name and logo aro registered marks of ACORD
<br /> 158
<br />
|