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1 ® DATE(MMIDD/YYYY) <br /> R <br /> A0 CERTIFICATE OF LIABILITY INSURANCE <br /> 11/29/2018 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACTNAME: <br /> Hub International Northwest LLC PHONE 360-647-9000 FAX <br /> No):360-734-8496 <br /> 110 Unity Street (A/CMA.ILo.Extl: <br /> Bellingham WA 98225 ADDRESS: now.bellinghaminfo©hubinternational.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Admiral Insurance Company 24856 <br /> INSURED PACISUR-01 INSURER B:American Hallmark Insurance Company 43494 <br /> Pacific Surveying&Engineering Services Inc INSURER C <br /> 909 Squalicum Way Ste 111 <br /> Bellingham WA 98225 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 1813621315 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 /> ADDL SUBR POLICY EFF POLICY EXP <br /> ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) LIMITS <br /> B GENERAL LIABILITY Y Y 44CL495755 10/19/2018 10/19/2019 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $100,000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> _GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> 7 POLICY X 178-- LOC $ <br /> B AUTOMOBILE LIABILITY Y Y 44CL495755 10/19/2018 10/19/2019 COMBINED SINGLE LIMIT <br /> (Ea accident) $1 000.000 <br /> X ANY AUTOBODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Per accident) <br /> $ <br /> B X UMBRELLA LIAB X OCCUR Y 44CL495755 10/19/2018 10/19/2019 EACH OCCURRENCE $3,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 <br /> DED X RETENTION$10,000 $ <br /> B WORKERS COMPENSATION 44CL495755 10/19/2018 10/19/2019 TORYWC LATU- X T H_ <br /> Stop Gap <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? 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 /> A Professional Liability E0000035343-03 10/19/2018 10/19/2019 Per Claim Limit 2,000,000 <br /> Aggregate Limit 2,000,000 <br /> Retention 25,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) <br /> Per policy forms and conditions:Artisans Advantage Enhanced Coverage Endorsement form MP 97 67 10 10,and Commercial Auto Coverage Form <br /> Enhancement Endorsement BA 20 60 04 11. <br /> Re:All Operations. The City of Everett,it's elected officials,employees and agents are included. <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 /> 3200 Cedar Street AUTHORIZED REPRESENTATIVE <br /> Everett WA 98201 <br /> i att216444 <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />