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ACORE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 41........----- 08/10/2017 <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 <br /> Niehl Insurance Agency PHONE FAX <br /> 375 118th Ave Se#103 (A/c,Nn Frt)• (425)644 1600 (A/C Noy(425)644-2152 <br /> E-MAIL <br /> Bellevue WA 98005 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> _ - INSURERA:The Hartford Casualty Insurance Co <br /> INSURED INSURER B:Sentinel Insurance Co. Ltd. <br /> Associated Earth Sciences Inc INSURER C: _ <br /> 911 5th Ave, Suite 100 INSURER D: <br /> Kirkland WA 98033 INSURERE: <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 ADDL!SUBR POLICY EFF 1 POLICY EXP <br /> TYPE OF INSURANCE <br /> LTRwsn I wvn POLICY NUMBER IMM/DD/YYYYI (MM/DD/YYY`Q LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY 52SBANW8675 12/31/201612/31/2017 EACH OCCURRENCE $ 1,000,000 _ <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED 300,000 <br /> PRFMISFS(Fa occurrence) $ <br /> MED EXP(Any one person)_ $ 10,000 <br /> iI PERSONAL&ADV INJURY _ $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: I', GENERAL AGGREGATE $ 2,000,000 <br /> POLICY X PRQ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY 52UECJR8403 12/31/201612/31/2017 (FOaaBcide°csINGLELIMIT $ 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> XHIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE <br /> I (Per accident) $ <br /> A X UMBRELLA LIAB X OCCUR ;52SBANW8675 12/31/2016h2/31/2017 EACH OCCURRENCE $ 5,000,000 <br /> EXCESS LIAB CLAIMS-MADE I AGGREGATE $ 5,000,000 <br /> DED RETENTION S $ <br /> A WORKERS COMPENSATION 52SBANW867512/31/201612/31/2017 SPERTATIITF 1 X FORH <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under I 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CITY OF EVERETT IS INCLUDED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT PER <br /> POLICY. <br /> CERTIFICATE HOLDER CANCELLATION Al 115733 <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 /> 3200 CEDAR ST <br /> EVERETT WA 98201- AUTHORIZED REPRESENTATIVE <br /> -- : ..1a_l <br /> + / , <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />