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Page 1 of 1 <br /> A�%2�® CERTIFICATE OF LIABILITY INSURANCE DATE <br /> )7/ 2o <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 /> c/o 26 Century Blvd <br /> (A/C,No.Ext): 1-877-945-7378 (A/C 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 /> INSURERA: Charter Oak Fire Insurance Company 25615 <br /> INSUREDINSURERS: Travelers Indemnity Company 25658 <br /> Perteet, Inc. <br /> PO Box 1186 INSURERC: Travelers Property Casualty Company of Ame 25674 <br /> 2707 Colby Avenue, Suite 900 INSURERD: Travelers Casualty and Surety Company of A 31194 <br /> Everett, WA 98201 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:W6960354 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 ADDL <br /> SPOLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE NW <br /> SD VD POLICY NUMBER LIMITS <br /> (MM/DD/YYYYI (MM/DD/YYYY) <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE RENTED <br /> CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 1,000,000 <br /> A MED EXP(Any one person) _ $ 10,000 <br /> 6805J284500 06/27/2018 06/27/2019 1,000,000 <br /> PERSONAL 8 ADV INJURY $ <br /> GE '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 06/27/2018 06/27/2019 BODILYINJURY(Per $ <br /> AUTOS ONLY AUTOS ( ) <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 /> PERX Stop Gap <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> Y/N <br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A UB6J664997 06/27/2018 06/27/2019 <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 06/27/2018 06/27/2019 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 # 20130279.100, Everett Downtown Streetscape - Rucker Avenue. <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 /> contract. <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: Ryan Sass AUTHORIZED REPRESENTATIVE <br /> 3200 Cedar j <br /> Everett, WA 98201 EP/f 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: 16488301 BATCH: 798145 <br />