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irk TBAILEY-01 MJOHNSON
<br /> '`\C0R11) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY)
<br /> kt.......------ 09/14/2017
<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 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
<br /> 12100 NE 195th Street,Suite 200 (a/°No,Ext):(425)489-4500 (A//c,No):(425)485-8489
<br /> Bothell,WA 98011 AD
<br /> E-MAIDRESS:now.info@hubinternational.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:ACE American Insurance Company 22667
<br /> INSURED INSURER B:Continental Casualty Company 20443
<br /> T Bailey Inc. INSURER C:
<br /> 12441 Bartholomew Rd. INSURER D:
<br /> Anacortes,WA 98221
<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 I POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD MD POLICY (MM/DD/YYYYI
<br /> A X COMMERCIAL GENERAL LIABILITY T ' I
<br /> l EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE 1—)-(1 OCCUR X X 624087566-009 09/01/2017'I 09/01/2018 PREM AMAGE SESO(Ea oecur RETEante ) $ 100,000
<br /> X STOP GAP MED EXP(Any one_person) _$ 10,000
<br /> X PROF/POLL 1,000,000
<br /> 1' PERSONAL&ADV INJURY $
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $._____ -
<br /> 2,000,000
<br /> POLICY X LOC PRODUCTS_COMP/OP AGG $ 2,000,000
<br /> OTHER: I $
<br /> COMBINED SINGLE LIMIT 1,000,000
<br /> A AUTOMOBILE LIABILITY (Ea accident) _ $
<br /> X ANY AUTO X X H08450171-009 09/01/2017 09/01/2018 BODILY INJURY(Per person) $
<br /> OWNED , SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> AUTOS ONLY NON-OWNEDUUPeer accidentDAMAGE $
<br /> $
<br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000
<br /> X EXCESS LIAB CLAIMS-MADE X X G24087578-009 09/01/2017 09/01/2018 AGGREGATE $ 10,000,000
<br /> I DED RETENTION$ $
<br /> A WORKERS COMPENSATION PEROTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE X ER
<br /> Y/N
<br /> G24087566-009 109/01/2017109/01/2018 I 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT I $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<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 /> B BUILDER'S RISK C2086745060 09/01/20171 09/01/2018 LIMIT:SEE BELOW
<br /> A Professional Liab. G24087566-009 09/01/2017 09/01/2018 DED: $10,000/LIMIT: 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: 17-0914 UP3662 WFP East Clearwell Roof Replacement
<br /> Additional Insured as required by written contract: the City of Everett,its officers,employees and agents.Coverage is primary&non-contributory.Waiver of
<br /> subrogation applies.See attached endorsements.Builder's Risk Limit:$3,022,197.06
<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 /> JV
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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