2019/01/23 Council Agenda Packet

• 1.2 ® ACD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) L----.- 9/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Stephen Emi Arthur J.Gallagher Risk Management Services, Inc. PHONEFAX 777 108th Ave NE,#200 (Nc.No.Ext):425-586-1002 (NC.No):425-451-3716 Bellevue WA 98004 ADDRESS: Stephen Emi@ajg.com INSURER(S)AFFORDING COVERAGE MAIC# INSURERA:Massachusetts Bay Insurance Company 22306 INSURED INSURER B:Allmerica Financial Benefit Insurance Co 41840 Village Theatre —303-Front--Street-North INSURER C: Issaquah,WA 98027 • INSURER D: . INSURER E: INSURER F: . COVERAGES CERTIFICATE NUMBER:1727511662 • REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE 1NSD_MD POLICY NUMBER (MM/DONYYYL(MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY ZD2-A738713-03 9/30/2018 9/30/2019 EACH OCCURRENCE $1,000,000 DAGE TO RENTED CLAIMS-MADE X OCCUR PREM SES(Ea occurrence) $100,000 MED EXP(Any one person) $1.0,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $3,000,000, X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: - $ B AUTOMOBILE LIABILITY AW2 A738703-03 9/30/2018 9/30/2019 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED • PROPERTY accident)DAMAGE $ AUTOS ONLY AUTOS ONLY . • $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR • CLAIMS-MADE AGGREGATE ' $ DED RETENTION$ $ $ A WORKERS COMPENSATION ZD2A738713-03 9/30)2018 9/30/2019 STATUTE X OOER TH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000 ff yes,describe under DESCRIPTION OF OPERATIONS belowEL DISEASE-POLICY LIMIT $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. •' . 2930 Wetmore Everett WA 98201 AUTHORIZED REPRESENTATIVE USA IA 41. I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logq,q2e registered marks of ACORD