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<br /> 4R^® CERTIFICATE OF LIABILITY INSURANCE DATE(Mri
<br /> M/DD/YY )
<br /> Ls 07/24/2018
<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(les)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 1-877-945-7378 FAX 1-888-467-2378
<br /> c/o 26 Century Blvd (AIC.No.Ertl: (A/C,No?:
<br /> E-MAIL certificates@willis.
<br /> P.O. Box 305191 ADDRESS: com
<br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE MAIC#
<br /> INSURER A: Charter Oak Fire Insurance Company 25615
<br /> INSURED INSURER B: Travelers Inriamni ty Company 25658
<br /> Perteet, Inc.
<br /> PO Box 1186 INSURER 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, AA 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 SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/OD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000
<br /> A
<br /> MED ECP(Any one person) $ 10,000
<br /> 6805,1284500 06/27/2018 06/27/2019 1,000,000
<br /> PERSONAL&ADV INJURY $
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X ECT X LOC PRODUCTS-COMP/OP AGG_ $ 2,000,000
<br /> OTHER $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> (Ea accident) $ 1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> B OWNED ONLY SCHEDULED
<br /> OSS
<br /> AUTOS . BA5J264770 06/27/2018 06/27/2019 BODILY INJURY(Per accident) $
<br /> HPROPERTY DAMAGE
<br /> AIUTOS ONLY _ AUTOSRED ONLY (Per accident) $ -
<br /> UMBRELLA LAB OCCUR
<br /> EACH OCCURRENCE _ $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILFY Y/N PER
<br /> X ER WA Stop Gap
<br /> C ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEM BER EXCLUDED? N/A UB6J664997 06/27/2018 06/27/2019
<br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000
<br /> D Professional Liability 106321064 06/27/2018 06/27/2019 Per Claim $3,000,000
<br /> Ay9. egate $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 /> AUTHORIZED REPRESENTATIVE
<br /> Attn: Ryan Sass
<br /> 3200 Cedar �!1 l'�G
<br /> Everett, wA 98201 1 24
<br /> lf�/ •
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
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