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<br /> ®
<br /> AccrREP
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 01/11/2018
<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 (AIC,NoL1-888-467-2378
<br /> c/o 26 Century Blvd E-MAIL
<br /> P.O. Box 305191 ADDRESS: certificates@willis.com
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA: Travelers Indemnity Company of CT 25682
<br /> INSUREDINSURERS: Phoenix Insurance Company 25623
<br /> Perteet, Inc.
<br /> PO Box 1186 INSURERC: 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/YLIMITS
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> X DAMAGE TO RENTED
<br /> CLAIMS-MADE OCCUR 1,000,000 PREMISES(Ea occurrence) $
<br /> A MED EXP(Any one person) $ 5,000
<br /> 6805,1284500 06/27/2017 06/27/2018 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY x JECT x LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> x ANY AUTO BODILY INJURY(Per person) $
<br /> g OWNED SCHEDULED BA5J284770 06/27/2017 06/27/2018 BODILYINJURY(Per $
<br /> AUTOS ONLY AUTOSaccident)
<br /> HIRED — NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE _$
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY STATUTE x ERH_WA Stop Gap
<br /> Y/N
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED? NIA UB6J664997 08/23/2017 06/27/2018 1,000,000
<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 /> D Professional Liability 106321064 06/27/2017 06/27/2018 Per Claim 3,000,000
<br /> Aggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I 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 AUTHORIZED REEPPRREESENTATjIVE
<br /> 3201 Smith Ave., Suite 215 Zi7� "/
<br /> Everett, WA 98201
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> SR ID: 15524498 BATCH: 566439
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