|
®
<br /> AccP DATE(MM/DD/YYYY)
<br /> ‘s......- CERTIFICATE OF LIABILITY INSURANCE 3/2/2018
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Carol Danell
<br /> NAME:
<br /> PLC Insurance, LLC (,HO No.Extia (425)712-3664 (A/C,NO): (425)712-3786
<br /> 4211 Alderwood Mall Blvd, #210 E-MADDRIESS:carold@plcins.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Lynnwood WA 98036 INsuRERA:Philadelphia Indemnity Ins Co.
<br /> INSURED INSURER B: ___
<br /> Bridgeways INSURER C:
<br /> 5801 - 23rd Dr. W. Suite 104 INSURERD:
<br /> INSURER E:
<br /> Everett WA 98203 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:18/19 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 EXPD WLIMITS
<br /> LTR INSVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000
<br /> A CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES 1,000,000
<br /> PREMISES(Ea occurrence) $
<br /> X PHPK1786282 3/2/2018 3/2/2019 MED EXP(Any one person) _$ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 3,000,000
<br /> X POLICY PRO LOC PRODUCTS $ 3,000,000
<br /> PRO-
<br /> JECT
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident) ,
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED PHPK17862826 3/2/2018 3/2/2019 BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS (Per accident) _
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR PHUB620064 3/2/2018 3/2/19 EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
<br /> DED RETENTION$ 10,000. $
<br /> womeeccom6WF[€xxor C
<br /> PER OTH-
<br /> STATUTE ER
<br /> AMEMPLOYERS'LIABILITY Y/N -
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> A (Mandatory in NH) PHPK1786282 3/2/2018 3/2/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below WA Stop Gap E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A Professional Liability PHPK1786282 3/2/2018 3/2/2019 Limit-Occurrence 1,000,000
<br /> Aggregate 3,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett, its officers, employees and agents are additional insured per attached CG2026 0413 and
<br /> PI-GLD-HS (10-11)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> 'RAMcCrary@everettwa.gov'
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn Rebecca McCrary ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Dept of Plannning & Community Dev
<br /> 2930 Westmore Ave AUTHORIZED REPRESENTATIVE
<br /> Suite 8A
<br /> Everett, WA 98201 Mike Rucker/SHANNB .r
<br /> ©1988-2014 ACORD CORPORATION. All All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025 r7o14on
<br />
|