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Client#: 54918 LACONSUL
<br /> YYYY)
<br /> /2018 M/DD/
<br /> ACORDr5 CERTIFICATE OF LIABILITY INSURANCE 8/14DATE(MM/DD/
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER ACT Trudy Henry
<br /> Greyling Ins. Brokerage/EPIC PHONE 770.552.4225 FAX 866.550.4082
<br /> (AIC,No,Ext): (A/C,No):
<br /> 3780 Mansell Rd.Suite 370 MAASS, hen //�� re lm com
<br /> ADDRESS: Y• rYl:g Y. g•
<br /> Alpharetta,GA 30022
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<br /> INSURER A:Sentinel Insurance Company 11000
<br /> INSURED INSURER B:Hartford Fire Insurance Co. 19682
<br /> LA Consulting, Inc. RLI Insurance Company INSURER C: P Y 13056
<br /> 124 11th Street
<br /> INSURER D:
<br /> Manhattan Beach, CA 90266
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 18-18 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 WLIMITS
<br /> LTRINSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 84SBWEH5998 11/01/2017 11/01/2018 EACH OCCURRENCE $1,000,000
<br /> D
<br /> CLAIMS-MADE X OCCUR PREMISESO(Eaoccurrence) $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X JECOT LOC PRODUCTS-COMP/OPAGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 84SBWEH5998 11/01/2017 11/01/2018(Eo aBclNdeDtSINGLE LIMIT _$1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> •
<br /> A X UMBRELLA LIAB X OCCUR 84SBWEH5998 11/01/2017 11/01/2018 EACH OCCURRENCE $1,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000
<br /> DED X RETENTION$10000 $
<br /> B WORKERS COMPENSATION 84WEGBM4189 11/01/2017 11/01/2018 X STATUTE EORH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> C Professional RTP0011509 12/03/2017 12/03/2018 Per Claim$1,000,000
<br /> Liability Aggregate$1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett,and its officers,employees and agents are named as Additional Insureds on the above
<br /> referenced liability policies with the exception of workers compensation&professional liability where
<br /> required by written contract.The above referenced liability policies with the exception of workers
<br /> compensation, umbrella and professional liability are primary&non-contributory where required by written
<br /> contract.Should any of the above described policies be cancelled by the issuing insurer before the
<br /> (See Attached Descriptions)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn: Grant Moen ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> #S1164801/M1082753 THEN2
<br />
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