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MOINV-3 OP ID: KM
<br />CERTIFICATE OF LIABILITY INSURANCE
<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 />DATE 612 01 YYj
<br />08!2612015
<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 Phone: 909-980-4211
<br />Silverstone Insurance Services
<br />Jetton & Assoc Ins Svs Inc Fax: 909-980785
<br />NAME: CONTACT
<br />PHONE
<br />qC o Ext): C No FAX
<br />E-MAIL
<br />ADDRESS:
<br />P.O. Box 1200 (Lie #0004829)
<br />Rancho Cucamonga„ CA 91 729-1 20 0
<br />Brent Jetton, AAI, CIC
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURERA: Hanover Insurance Company
<br />INSURED Mobilitie LLC
<br />INSURERS: Great American EBBS Ins Co 37532
<br />2220 University Drive
<br />Newport Beach, CA 92660
<br />INSURERC:
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />INSURER D :
<br />INSURER E :
<br />ZHQ836174510
<br />INSURERF:
<br />10111!2015
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />AUL)Ll!=
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />POLICY NUMBER
<br />POLICY
<br />MMIDD EFF
<br />MMID POLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,00
<br />ED
<br />PREMISES Ea occurrence $ 500,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />X
<br />ZHQ836174510
<br />10/11/2014
<br />10111!2015
<br />CLAIMS -MADE F OCCUR
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,00
<br />CONTRACTUAL LIABILITY
<br />GENERAL AGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />POLICY PR—'-- X LOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,00
<br />Ea accident $
<br />BODILY INJURY (Per person) $
<br />A
<br />ANY AUTO
<br />X
<br />AHQ8171567
<br />10/11/2014
<br />10/11/2015
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />Ix
<br />BODILY INJURY (Per accident) $
<br />HIRED AUTOS X AUTO QED
<br />PROPERTY
<br />acccidenDAMAGE $
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,00
<br />AGGREGATE $ 5,000,00
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />X
<br />UHQ8180786
<br />10/11/2014
<br />10/11/2015
<br />DED I I RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE Y�
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />HQ8171579
<br />10/11/2014
<br />10/11/2015
<br />X WC STATU- _707TH -
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I E . DISEASE - POLICY LIMIT $ 1,000,00
<br />B
<br />Pollution Liab
<br />PRE315985700
<br />10/11/2014
<br />10/11/2015
<br />Aggregate 5,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />If required by written contract, City of Everett, its officers, officials,
<br />boards, commissions, employees, agents, representatives, and volunteers are
<br />additional insureds with respects to general liability, auto liability and
<br />excess liability. Primary/Non-Contributory Wording applies. See Holder Notes
<br />for cancellation wording.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITEV01
<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
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Paul McKee
<br />AUTHORIZED REPRESENTATIVE
<br />3200 Cedar Street
<br />Everett, WA 98201
<br />O 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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