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Client#: 129019 FORMCONS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 7108/2019(MM/DD(MMIDD/YYYY) 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Ashlee Wright Propel Insurance PHONE 800 499-0933 FAX 866 577-1326 (NC,No,Ext): (A/C,No): Tacoma Commercial Insurance E-MAIL ADDRESS: ashlee.wrig t ht/�pp ro elinsurance.com 1201 Pacific Ave,Suite 1000 INSURER(S)AFFORDING COVERAGE NAIC# Tacoma,WA 98402 Zurich American Insurance Company 16535 INSURER A: P Y INSUREDINSURER B:Travelers Property Casualty CoofAmerica 25674 Forma Construction Company Illinois Union Insurance Com an 27960 INSURER c: Company PO Box 11489 INSURER D: Olympia,WA 98508 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTRINSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X GLA019886303 07/09/2019 07/09/2020 EACH � S(EOCCURRENCE $1,000,000 PREMISE _ CLAIMS-MADE X OCCUR s occcu ence) $300,000 X PD Ded:25,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY X IMT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X GLA019886303 07/09/2019 07/09/2020Ea COMaccidBINEDenqSINGLE LIMIT $1,000,000 ( X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) $ B X UMBRELLA LIAB X OCCUR X X ZUP16N2556A19NF 07/09/2019 07/09/2021 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 DED RETENTION$ $ A WORKERS COMPENSATION GLA019886303 07/09/2019 07/09/2020 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER OANY PRIETOR/EXCLUDED?EECUTIVE N N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution/Prof COOG23897854012 07/09/2018 07/09/2020 $3,000,000 OCC Liability $3,000,000 AGG DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re: Job Order Contracting for the City of Everett-year 3. The City of Everett,its officers,employees and agents are included as additional insureds per the attached endorsements. CERTIFICATE HOLDER CANCELLATION Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3200 Cedar Street ACCORDANCE WITH THE POLICY PROVISIONS. Everett,WA 98201 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3711566/M3711458 ATWOO