|
INTECON-15 LSTURROCK
<br /> ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE7/14/2017YY)
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Hub International Northwest LLC PHONE Fax
<br /> 12100 NE 195th Street,Suite 200 (A/c,No,Ext):(425)4894500 (A/C,No):(425)485-8489
<br /> Bothell,WA 98011 AODREss:now.info@hubinternational.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA:Liberty Mutual Fire Insurance Company 23035
<br /> INSURED INSURER B:Liberty Insurance Corporation 42404
<br /> Interwest Construction Inc. INSURER C:Indian Harbor Insurance Company 36940
<br /> 609 North Hill Blvd INSURERD:
<br /> Burlington,WA 98233
<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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD (MM/DD/YYYY� (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X x TB2Z91463997037 07/01/2017 07/01/2018 PREMISES(Eaoccurrence) $ 100,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1'000,000
<br /> GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> _ OTHER: $
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br /> (Ea accident) $
<br /> X ANY AUTO X X AS2Z91463997027 07/01/2017 07/01/2018 BODILYINJURY(Perperson) $
<br /> OWNED SCHEDULED
<br /> AUTOSRE� ONLY _ AUTOS
<br /> WN PBODILY INJURY(Per accident) $
<br /> AUTOS ONLY _ AUTO ONLDY (Perr acodeenntIAMAGE
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE X X TH7Z91463997047 07/01/2017 07/01/2018 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> A WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY STATUTE X 2-4H-
<br /> AND
<br /> 07/01/2017 07/01/2018 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> (Mandatory in NH)EXCLUDED? N/A 1,000,000
<br /> E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C POLL/PROF** x x PEC004576703 07/01/2017 07/01/2018 OCC/AGG 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:Job 1157 Grand Ave Bridge
<br /> City of Everett,Contracting Agenty and its officers,elected officials,employees,agents and volunteers are added as addtional insureds.Coverage is Primary
<br /> and Non Contributory
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Cityof Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|