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! l <br /> ® <br /> ACCPRfl CERTIFICATE OF LIABILITY INSURANCE DATEYYY) <br /> os/01/20ol/zo12 • <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 1-804-000-0000 CONTACT <br /> NAME: Carolyn O. Varnier <br /> Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX <br /> (A/C,No.Ext): 804-916-6846 <br /> 4860 Cox Road, Suite 200 E-MAIL <br /> ADDRESS: (A1C,No): 804-916-6897 <br /> Glen Allen, VA 23059 INSURER(S)AFFORDINGCOVERAGE NAIC# <br /> Carolyn O. Varnier INSURER A: LM INS CORP 33600 <br /> INSURED INSURER B: <br /> ICF JONES & STOKES, INC. <br /> INSURER C <br /> • <br /> 9300 LEE HIGHWAY INSURERD: <br /> INSURER E: <br /> FAIRFAX, VA 22031 <br /> _ INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 26967250 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 EFF POLICY EXP <br /> LTYPE OF INSURANCE ADDL SUER POLICY NUMBER (MM/DDPOLICY/YYYY) MM/DDIYYYY) LIMITS <br /> LTR JN " WVD S <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE TO RENTED <br /> COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ _ <br /> CLAIMS-MADE OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PEC ri LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> 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 /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED _RETENTION$ $ <br /> A WORKERS COMPENSATION TO <br /> WC5-Z31-508381-011 06/25/11 06/25/12 x RYLIAMITS ER <br /> IO <br /> AND EMPLOYERS'LIABILITY <br /> Y/N 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECU77VE N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> PROFESSIONAL SERVICES AGREEMENT <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 /> S <br /> 3200 CEDAR STREET AUTHORIZED REPRESENTATIVE <br /> EVERETT, WA 98201 <br /> USA <br /> VORCCA <br /> ©1988-2010 <br /> ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br /> carolynvar <br /> 26967250 8 6 <br />