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<br /> AC 0• DATE(M 6//201)
<br /> I`� CERTIFICATE OF LIABILITY INSURANCE
<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.If
<br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this I.=
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). m
<br /> PRODUCER CONTACT a
<br /> NAME:
<br /> Aon Risk Services Northeast, Inc. PHONE -
<br /> New York NY Office (AIC.No.Ext): (866) 283-7122 (AIC No.): (800) 363-0105 -LOO
<br /> One Liberty Plaza E-MAIL 470
<br /> 165 Broadway, Suite 3201 ADDRESS:
<br /> New York NY 10006 USA
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: National Union Fire Ins CO of Pittsburgh 19445
<br /> Seattle SMSA Limited Partnership INSURER B: New Hampshire Insurance Company 23841
<br /> dba verizon Wireless
<br /> 1095 Avenue of the Americas INSURER C: American Home Assurance CO. 19380
<br /> New York NY 10036 USA INSURER D: Illinois National Insurance Co 23817
<br /> INSURER E: Lloyd's Syndicate NO. 33 AA1126033
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 570073665820 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. Limits shown are as requested
<br /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD MD POLICY NUMBER ((MMIDD/YYYYI fINM/DINYYY11 LIMBS
<br /> A X COMMERCIAL GENERAL LIABILITY GL4611607 06/30/2018 06/30/2014 EACH OCCURRENCE $5,000,000
<br /> CLAIMS-MADE n OCCUR DAMAGE TO RENTED $5,000,000
<br /> PREMISES(Ea occurrence)
<br /> X XCU Coverage is Included MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $5,000,000 N
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 PA
<br /> X POLICY PRO LOC PRODUCTS-COMP/OPAGG $5,000,000 oto_ o
<br /> OTHER: 0
<br /> N-
<br /> A AUTOMOBILE LIABILITY CA 461-15-19 06/30/2018 06/30/2019 COMBINED SINGLE LIMIT $5,000,000
<br /> AOS (Ea accident) ,
<br /> A X ANY AUTO CA 461-15-20 06/30/2018 06/30/2019 BODILY INJURY(Per person) O
<br /> Z
<br /> OWNED —SCHEDULED MA BODILY INJURY(Per accident) d
<br /> A AUTOS ONLY _AUTOS CA 461-15-21 06/30/2018 06/30/2019 PROPERTY DAMAGE ca
<br /> HIRED AUTOS NON-OWNED
<br /> ONLY _AUTOS ONLY VA (Per accident) w
<br /> A See Next Page 06/30/2018 06/30/2019 m
<br /> E X UMBRELLALIAB X OCCUR CSUSA1801284 06/30/2018 06/30/2019 EACH OCCURRENCE $2,000,000 0
<br /> EXCESS LAB CLAIMS-MADE AGGREGATE $2,000,000
<br /> DED X RETENTION$10,000
<br /> B WORKERS COMPENSATION AND WC014590551 06/30/2018 06/30/2019 X PER
<br /> UTE ETH
<br /> EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN AOS E.L.EACH ACCIDENT $3,000,000
<br /> C OFFICER/MEMBEREXCLUDED? N NIA WC014590550 06/30/2018 06/30/2019
<br /> (Mandatory in NH) CA E.L.DISEASE-EA EMPLOYEE $3,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $3,000,000—
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> RE: Site Name: Quiet Water, Site Address: 3113 Oakes Avenue, Everett, wA 98201, Project# 272016, Location Code: 404166.
<br /> The City of Everett Franchise, its officers, officials, agents (excluding City construction contractors and their
<br /> subcontractors), employees and volunteers are included as Additional Insured with respect to the General Liability and 14
<br /> Automobile Liability policies. The General Liability and Automobile Liability policies shall apply as Primary Insurance to
<br /> each Additional Insured listed herein. Where permitted by law, the Named Insured parties listed herein waive all rights
<br /> against the The City of Everett Franchise, its officers, officials, agents (excluding City construction contractors and their _IV
<br /> subcontractors), employees and volunteers for recovery of damages to the extent these damages are covered by the Workers'
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE '1—¢J--�i
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS.
<br /> The City of Everett Franchise AUTHORIZED REPRESENTATIVE
<br /> 3113 Oakes Ave.
<br /> Everett WA 98201 USA `'� � ��g MA
<br /> a MA
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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