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<br /> A J I �j DATE(MM/DD/Y YY)
<br /> r CERTIFICATE OF LIABILITY INSURANCE • 01/11/208.
<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 /> Willis of Oregon, Inc. PHONE FAX
<br /> (A/C.No,Ext): 1-877-945-7378 (A/C,No): 1-888-467-2378
<br /> c/o 26.Century Blvd E-MAIL
<br /> P.O. Box 305191 ADDRESS: certificates@willis.com
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAIC#
<br /> 'INSURER A: Travelers Indemnity Company of CT 25682
<br /> INSURED INSURER B: Phoenix Insurance Company 25623
<br /> Perteet, Inc.
<br /> PO Box 1186 INSURER C: Travelers Property Casualty Company of Ame 25674
<br /> 2707 Colby Avenue, Suite 900 INSURER D• Travelers Casualty and Surety Company of A 31194
<br /> Everett, WA 98201
<br /> INSURER E:
<br /> _ INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:W5092573 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 LIMITS
<br /> LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MWDD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTE
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occur ence) $ 1,000,000
<br /> A MED EXP(Any one person) $ 5,000
<br /> 68053284500 06/27/2017 06/27/2018 PERSONAL BADV INJURY $ 1',000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000
<br /> POLICY X JECOT- X LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> jEa accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED BA5J284770 06/27/2017 06/27/2018 BODILY (Per $
<br /> AUTOS ONLY - AUTOS ( )
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY _ AUTOS ONLY (Per accident)
<br /> $
<br /> UMBRELLA LIAB OCCUR • EACH OCCURRENCE $ _
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> •
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY STATUTE X ER
<br /> WA Stop Gap
<br /> Y/N
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED? N/A uB6J664997 08/23/2017 06/27/2018
<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 /> D Professional Liability 106321064 06/27/2017 06/27/2018 Per Claim 3,000,000
<br /> Aggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Project #20170146
<br /> Project Name: Everett Station Park & Ride Expansion
<br /> Per Project Aggregate applies when required by written contract. General Aggregate Capped at $8,000,000.
<br /> City of Everett is included as an Additional Insured as respects to General Liability, as required by written
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Everett
<br /> Attn: Tom Hingson •
<br /> AUTHORIZED REPRESENTATIVE
<br /> Smith Ave., Suite 215 Z'7� t"/
<br /> Everett, WA 98201
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logola'I1e4egistered marks of ACORD
<br /> SR ID: 15524498 BATCH: 566439
<br />
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