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DATE(MM/DD/YYYY) <br /> AC <br /> c CERTIFICATE OF LIABILITY INSURANCE 8/15/2017 <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 CONTACT Jim Ledbetter <br /> NAMEHall&Company PHONE FAX <br /> 19660 10th Ave NE (A/C.No.Fxt) 360-626-2019 (A/C.No):360-598-3703 <br /> Poulsbo WA 98370 n oRless:lledbetter@hallandcompany.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Sentinel Insurance Company 11000 <br /> INSURED 9896 INSURER B:Hartford Casualty Insurance Company 29424 <br /> Sazan Group Inc INSURER c:Trumbull Insurance Company 27120 <br /> 600 Stewart Street, Ste 1400 INSURER D:Arch Insurance Company 11150 <br /> Seattle WA 98101 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:765606784 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 EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> B X COMMERCIAL GENERAL LIABILITY Y Y 52SBAPN0916 8/1/2017 8/1/2018 EACH OCCURRENCE $2,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED <br /> PREMISES(Ea occurrence) $300,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $2,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $4,000,000 <br /> POLICY X PECOT- LOC _PRODUCTS-COMP/OP AGG $4,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY Y Y 52UECZN6443 8/1/2017 8/1/2018 COMBINE!--SINGLE LIMIT-- $ <br /> (Ea accident) 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOS/NED SCHEDULED BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per accident) <br /> B X UMBRELLA LIAB X OCCUR Y Y 52SBAPN0916 8/1/2017 8/1/2018 EACH OCCURRENCE _ $4,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 <br /> DED X RETENTION$10,000 $ <br /> C WORKERS COMPENSATION Y 52WECGH1731 8/1/2017 8/1/2018 PERX ETH- WA Stop <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER Gap <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> D Professional Liab;Claims Made PAAEP0027900 8/1/2017 8/1/2018 $2,000,000 Per Claim <br /> $4,000,000 Aggregate <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Certificate holder is/are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or <br /> agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and <br /> any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A waiver of <br /> subrogation applies to the Commercial General Liability,Auto Liability, Umbrella/Excess Liability and Employers Liability/WA Stop Gap in <br /> favor of the Additional Insured. <br /> City of Everett, and its officers, employees and agents as additional insureds <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 /> 2930 Wetmore Avenue ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Suite 10-C <br /> Everett WA 98201 <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />