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BURTCON-01 KDIEHL
<br /> ACORO DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 06/28/2017
<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 Kris Diehl
<br /> NAME:
<br /> BK-JET Group,LLC PHONE FAX
<br /> 999 W Riverside Avenue,Suite 510 (A/C,No,Ext):(509)319-2908 (AIC,No):(509)319-2920
<br /> Spokane,WA 99201 p IDARIk„gq:kdiehl@ bkjet.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC S _
<br /> INSURER A:Phoenix Insurance Co. 25623
<br /> INSURED INSURER B:Travelers Property Casualty Company of America 25674
<br /> Burton Construction,Inc. INSURER c:Alaska National Insurance Company 38733
<br /> 3915 E Nebraska INSURER D:
<br /> Spokane 99217
<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 WPOLICY NUMBER (M /YPOLICY EFF POLICY EXP LIMITS
<br /> LTR INSD VD MIDD/YYYYI IMMIDDYYYI
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR DT-CO-5J58662A-PHX-17 07/07/2017 07/07/2018 DAMAGETORENTED 100,000
<br /> X X PREMISES(Ea occurrence) $
<br /> X $2,500 PD Deductible _ MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
<br /> 2,000,000
<br /> POLICY X JP
<br /> LOC PRODUCTS-COMP/OP AGG, $ 2,000,000
<br /> OTHER: WA STOP GAP $ 1,000,000
<br /> COMBINED SINGLE LIMIT 1,000,000
<br /> A AUTOMOBILE LIABILITY LEa accident)
<br /> X ANY AUTO DT-810-5J58662A-PHX17 07/07/2017 07/07/2018 BODILYINJURY(Perperson) $
<br /> OWNED I SCHEDULED
<br /> AUTOS ONLY L. AUTOS BODILY INJURY(Per accident) $
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $
<br /> I I
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE CUP-9H882519-17-26 07/07/2017 07/07/2018 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> C WORKERS COMPENSATION X EM
<br /> OTH-
<br /> AND EMPLOYERS'LIABILITY ,STATUTE ER
<br /> 16H WS 10279 08/22/2016 08/22/2017 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N! E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? NIA ,000,000
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101 Additional Remarks Schedule,may be attached If more space is required)
<br /> AS RESPECTS JOC FOR GENERAL CONSTRUCTION SERVICES CONTRACT#2014-061 CITY OF EVERETT
<br /> ADDITIONAL INSURED STATUS INCLUDING WAIVER OF SUBROGATION IS GRANTED AS IT RELATES TO GENERAL LIABILITY IN ACCORDANCE WITH
<br /> TERMS AND CONDITIONS OF THE POLICY TO CITY OF EVERETT PER THE ACTUAL FORMS ATTACHED TO THIS CERTIFICATE.UMBRELLA FOLLOWS
<br /> FORM AS IT RELATES TO ADDITIONAL INSUREDS.THE ABOVE COVERAGE IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN
<br /> CONTRACT.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> CITY OF THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> CITY OF EVERETT EACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200CE
<br /> S
<br /> EVERETT,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> 60/71 Ly,Nde7011--"'N—
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
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