Forterra 12/22/2017 - Laserfiche WebLink

ACC) o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/4/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT (OR) Heffernan Insurance Brokers PHONE FAX 5100 SW Macadam, Suite 440 IA/C.No.Ext); 503-226-1320 (A/C,No):503-226-1478 Portland OR 97239 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:First National Insurance Company of America 24724 INSURED FORTERR-01 INSURER B:American States Insurance Company 19704 Forterra 901 Fifth Ave.#2200 INSURER C:Travelers Casualty and Surety Company of America 31194 Seattle WA 98164 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:56743794 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIALGENERALLIABILITY Y 25CC36185150 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000 — X WA Stop Gap: MED EXP(Any one person) $20,000 $3MM/$1MM/$IMM PERSONAL 8 ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y 25CC36185150 7/1/2017 7/1/2018 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS — X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR 01SU43052550 7/1/2017 7/1/2018 EACH OCCURRENCE _ $10,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$10 000 ,Prod/Comp Ops Agg $10,000,000 WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N ST TUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Professional Liability 105620248 6/9/2017 6/9/2018 Each Claim Limit $1,000,000 Retroactive 6/9/2006 Deductible $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required) Re:As Per Contract or Agreement on File with Insured.City of Everett,its officers,employees and agents are included as an additional insured(and primary) on General Liability and Automobile Liability policies per the attached endorsements, if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Everett Attn:Cory Rettenmier, Parks AUTHORIZED REPRESENTATIVE and Community Services Manager 802 E. Mukilteo Blvd. 0/11 ' 'Everett,WA 98203 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD