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DATE(MM/DD/YYYY) <br /> ACRDS CERTIFICATE OF LIABILITY INSURANCE <br /> 5/21/2018 <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 CL Central <br /> NAME: <br /> Leavitt Group Northwest IA/C.No.Ext):ONE (866)298-0570 FAX <br /> IA/ (866)688-5709 <br /> PO Box 9068 EaWAIL <br /> ADDREss:cicnorthwest@leavitt.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Tacoma WA 98490 IN5uRERAAmerican Fire & Casualty Company 24066 <br /> INSURED INSURER B:Oh1O Security Insurance Company 024082 <br /> Triangle Associates Inc INsuRERc:Underwriters at Lloyds of London 15792 <br /> 811 First Ave #255 INSURERD: <br /> INSURER E: <br /> Seattle WA 98104 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:17/18 Master 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 POUCY EFF POUCY EXP WLIMITS <br /> LTR INSD VD POLICY NUMBER IMM/DD/YYYY) IMM/DD/YYYYI <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE RENTED <br /> A CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 1,000,000 <br /> X BKA55302282 10/23/2017 10/23/2018 MED EXP(Any one person) $ 15,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 <br /> X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 <br /> OTHER: $ <br /> AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> B ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BAS55302282 10/23/2017 10/23/2018 BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> X HIRED AUTOS x AUTOS (Per accident) <br /> $ <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE X ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICA (MandatoryaIn NH)ER EXCLUDED? BKA55302282 10/23/2017 10/23/2018 <br /> In 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 /> C Professional Liability MPL103380517 7/13/2017 7/13/2018 PerCliaim 1,000,000 <br /> Deductible 5,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> City of Everett is named additional insured with respects to general liability on primary and <br /> non-contributory basis and waiver of subrogration per written contract with the named insured form <br /> CG88100413, completed operations form CG85830413. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ltobin@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 /> Public Works Dept ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3200 Cedar St <br /> Everett, WA 98201 AUTHORIZED REPRESENTATIVE <br /> PJ zcGilmer/PJGILM <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> INS025(201401) <br />