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HYDRSTA-01 AMICHEL <br /> ACRID DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> 05/31/2018 <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 /> NAAME: <br /> Hub International Northwest LLC PHONE No,Ext):(425)4894500 I FAX 4854489 <br /> 12100 NE 195th Street,Suite 200 E-MAIL <br /> Bothell,WA 98011 ADOREss:now.info@hubinternational.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:SCOttSdale Insurance Company 41297 <br /> INSURED INSURER B: <br /> Hydrology Stand Up Paddle,LLC INSURER C: <br /> 4816 College Ave INSURERD: <br /> Everett,WA 98203 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTRINSD WVD (MMIDD/YYYYI (MMIDD/YYYYI <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 <br /> MAGE TO <br /> CLAIMS-MADE �X 1 OCCUR X CPS3053266 06/10/2018 06/10/2019 •D;ARENTED, <br /> ul � 100,000= s <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL 8 ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY 1 JEcr L__ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: STOP GAP $ 1,000,000 <br /> AUTOMOBILECOMBINED SINGLE LIMIT <br /> LIABILITY <br /> (Ea accident) <br /> _ ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ _ <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY (Per accident) $ <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEDJ RETENTION$ I $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY Y/N STATUTER H <br /> ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> ( andatory n NNH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> Re:Project Service Agreement <br /> The City Of Everett,Its Officers,Agents And Employees are included as Additional Insured per the attached forms/endorsements. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> CityOf Everett Parks&Recreation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 802 MUKILTEO BLVD <br /> Everett,WA 98203 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />