|
Page 1 of 2
<br /> ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 07/09/2018
<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 Minnesota, Inc.
<br /> c/o 26 Century Blvd (A/D.No,Ext): 1-877-945-7378 FAX
<br /> No): 1-888-467-2378
<br /> E-MAIL certificates@willis.com
<br /> P.O. Box 305191 ADDRESS:
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A: Liberty Mutual Fire Insurance Company 23035
<br /> INSUREDINSURERS: Liberty Insurance Corporation 42404
<br /> HDR Engineering, Inc.
<br /> 8404 Indian Hills Drive INSURER C:
<br /> " Omaha, NE 68114 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:W6877562 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
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1,000,000
<br /> PREMISES(Ea occurrence) $
<br /> A - X Contractual Liability MED EXP(Any one person) $ 10,000
<br /> Y Y TB2-641-444950-038 06/01/2018 06/01/2019 PERSONAL BADV INJURY $ 2,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY X jE X LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y AS2-641-444950-048 06/01/2018 06/01/2019 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESSLIAB CLAIMS-MADE Y Y TH7-641-444950-068 06/01/2018 06/01/2019 AGGREGATE $ '5,000,000
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION - X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> Y/N
<br /> B ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? No NIA Y WA7-64D-444950-018 06/01/2018 06/01/2019 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 /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella/Excess
<br /> Liability on a Primary, Non-contributory basis where required by written contract. Waiver of Subrogation applies on
<br /> General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation where required by written
<br /> contract. Umbrella/Excess policy is Follows Form over General Liability, Auto Liability and Employers Liability.
<br /> Project: The city of Everett would like us to review original RTB concept to verify the city would still meet
<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 /> AUTHORIZED REPRESENTATIVE
<br /> Attn: Souheil Nasr
<br /> 3200 Cedar St.
<br /> Everett, WA 98201 1 /�
<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: 16425745 BATCH: 779194
<br />
|