201 MAIN ST-CERT OF INS.pdf---"N SPEEWES-01 AMIGHEL
CERTIFICATE OF LIABILITY INSURANCE DATE (MMfDDNYYY)
1 03/09/2018
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(les) 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 andorsement(s).
CONTACT
PRODUCER NAME:
Hub International Northwest LLC PHONE
A/C. N9,gjm: t425) 489-4500 No):(425) 485-8489
12100 NE 195th Street, Suite 200
Bothell, WA 98011 J�0%160. now.info0hubintemational.cm
prr--.�CENED INSURERIS) AFFORDIING C—CM—MM NAIC 0
IN URERA:West American Insurance Co 44393
INSURED MAR 12 2018 INSURER B: American Fire and Casually Company 24066
Edmonds 2020, LLC INSURERC:Starr Indemnily and Liabilily 38318
307 Bell Street, Ste 101 ENGINEERING DIVISION
Edmonds, WA 98020 1 !!T!
COVERAGES CERTIFICATE NUMBER: IREVISION NUM11:51--11:
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.
�ADDLSUBR Poll ICY EXP I
INSR! TYPE OF INSURANCE POLICY NUMBER LIMITS
LTR &6um -
A I X i com ERCIAL GENERAL LIABILITY g6q�j QPC RENPEw -f- 1000000
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MCLAIMS -MADE I X i OCCUR X � X EIKW64732230 0311012018 03/1012019 DAMAGE TO RENTED
MILOWAMM) S — ...
GEI?LAGGREQATE
LIMIT APPLIES PER:
POLICY LXJ
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OTHER:
AUTOMOBILE LIABILITY
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584967181 03/10120181 03/10/2019
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
Re: Permit #ENG20170001 and #ENG20170033
City -of Edmonds Is Included as Additional Insured perthe attached formsiendomements.
TE HOLDER
City of Edmonds
Engineering Division
121 5th Ave N
EDMONDS, WA 98020
17
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE NTH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
110;40�
ACORD 25 (2016/03)
0 1988-2016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
CG 88 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUBJECT
NON -OWNED AIRCRAFT
NON -OWNED WATERCRAFT
PROPERTY DAMAGE LIABILITY -ELEVATORS
EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tonant's Property Damage)
MEDICAL PAYMENTS EXTENSION
EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT
PRIMARY AND NON-CONTRlIBU`rORY- ADDITIONAL INSURED EXTENSION
ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE'
WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN
INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
KNOWLEDGE OF OCCURRIENCF_ OFFENSE. CLAIM OR SUIT
LIBERALIZATION CLAUSE
BODILY INJURY REDEFINED
EXTENDED PROPERTY DAMAGE
WARIFER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
EM
2
2
2
2
3
3
3
7
7
7
7
7
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With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by
the endorsement
A. NON -OWNED AIRCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
exclusion g. Aircraft, Auto Or Watencraft does not apply to an aircraft provided:
1. It Is not owned by any Insured;
2. It Is hired, chartered or loaned with a trained paid crew;
3. The pilot In command holds a currently effective certificate, Issued by the duly consfltuted authority of
the United States of Arner.cs or Can3da. designating her or him a commercial or airlIne pilot; and
4. It is not being used to carry persons or property for a charge.
However, the Insurance afforded by this provision does not apply if there is available to the insured other
valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically
In excess of this policy), contingent or on any other basis, that would also apply to the loss covered under
this provision.
B. NON -OWNED WATERCRAFT
11 - Coverage A - Bodily Injury And Property Damage Liability,
4 Under Paragraph 2. Exclusions of Section I
8 Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following:
lii� This exclusion does not apply to:
(2) A watercraft you do not own that Is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or prop" for a charge.
C. PROPERTY DAMAGE LIABILITY - ELEVATORS
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Uabll-
Ity, Su::paragraphs (3), (4) and (6) of exclusion J. Damage To Proporty do not app�y 111' such "property
clalldgo* results from the use of elevators. For the purpose of this vrovIsion, e;evalcrs do not includp
vehicle lifts. Vehicle lifts are lifts or hoists used In automobile service or repair operations.
2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other
Insurance, Paragraph b. Excess Insurance:
The insurance afforded by this provision of this endorsement is excess over any property insurance,
whether primary, excess, contingent or on any other basis.
D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (renant's Property Damage)
If Damage To Premises Rented To You Is not otherwise excluded from this Coverage Part:
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability:
a. The fourth from the last Paragraph of exclusion J. Damage To Property is replaced by the follow-
Ing:
Paragraphs (1). (3) and (4) of this exclusion do not apply to "property damage' (other than damage
by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to:
(Q Promises rented to you for a period of 7 or fewer cormecutive days; or
(IQ Contents that you rent or lease as part of a promises rental or lease agreement for a period of
more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage' to contents of
promises rented to you for a period of 7 or fewer consecutive days.
A separate limit of Insurance applies to this coverage as described In Section III - Limits of
Insurance.
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b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage
from automatic fire protection systems to promises while rented to you or temporarily occupied by
you with permission of the owner. A separate lirrilt of Insurance applies to Damage To Premises
Rented To You as described in Section III - Limits Of Insurance.
2. Paragraph 6. under Section III - Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit Is the most we will
pay under Coverage A for damages because of 'property damage' to:
a. Any one premise:
(1) While rented to you; or
(2) While renlad to you or temporarily occupied by you with pernnission of the owner for
damage by fire, lightning, explosJon, smoke or leakage from automatic protection sys-
tems; or
b. Contents that you rent or lease as part of a premises rental or lease agreement.
3. As regards coverage prtrwided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO
YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following:
R.a. A conbract for a lease of Premises. However, that portion of the contract for a lease of premises
that Indemnities any person or organization for damage by fire, lightning. explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporaft
occupied by you with the pem*Aon of the owner, or for damage to contents of such Premises
that are Included in your premises rental or lease agreement. Is not an 'Insured contract'.
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy
are arronded 3s follows:
Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments. Subparagraph
(b) of Paragraph a. is replaced by the following:
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
1. Under Supplementary Payments - Coverages A and B, Paragraph I.b. Is replaced by the following:
b. Up to $3,006 for cost of bail bonds required because of accidents or traffic Law violations arising
out of the use of any vehicle to which the Bodity Injury Usibility Coverage applies. We do not have
to furnish these bonds.
2. Paragraph I.d. is replaced by the following:
d. An reasonable expenses incurred by the insured at our request to assist us in the Investigation or
defense of the claim or 'suit'. including actual loss of earnings UP to $500 3 day because of time
off from work.
G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section 11 - Who Is An Insured is amended 10 inducle as an insured any person or
organization whom you have agreed to add as an additional Insured in a written contract, wntten
agreerrient or permit. Such person or organization is an additional Insured but only with respect to
liability for "bodily injury% *property damage' or 'personal and advertising injury' caused in whole
or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided that the 'bodily injury' or *property damage* occurs. or the 'Per-
sonai and advertising injury' is committed, subsequent to the signing of such written contract or
written agreement; or
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b. Promises or facilities rented by you or used by you; or
c. The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or
d. Operations Performed by you or on your behalf for which the state or political subdivision has
issued a permit subject to the following additional provisions:
(1) This insurance does not apply to 'bodily Injury, "property damage', or "personal and ad-
veritising injury" arising out of the operations performed for the state or political subdivision;
(2) This Insurance does not appty to "bodily injury" or 'property damage' Included within the
"Completed operations hazard".
(3) Insurance applies to promises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, ownIngs, canopies, cellar entrances, coal holes, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance. or use of any elevators covered by this insurance.
However
1. The insurance afforded to such additional insured only applies to the extent permitted by law, and
2. If coverage provided to the udditional Insured Is required by a contract or agreement, the insur-
ance aflorded to such additional Insured will not be broader than that which you are required by
the contract or agreement to provide for such additional insured
With respect to Paragraph I.e. above, a person's or organization's status as an additional insured
under this endorsement ends when:
(1) All work, inciuding materials. Parts or equipment lumishep in connection wth such worK on
the project (other than service. maintenance or Weirs) to be performed try or on behalf of the
additional insured(s) at the location of the covered operallons has been completed; of
(2) That portion of 'your work' out of which the Injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged In performing operations for a principal as a part of the same project.
With respect to Paragraph I.b. above, a person's or organization's status as an additional insured
under this endorsement ends when their written contract or written agreement with you for such
promises or facilities ends.
Wiln respects to Paragraph i.c. above, this insurance does no! apply to arry u*ccurrence" which takes
place alter the equipment rental or lease agreement has expired or you have returned such equipment
to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement
Is signed prior to the 'bodily injury" or 'property damage.
We have no duty to defend an additional insured under this endorsement until we receive written
notice of a "suit" by the additional Insured as required in Paragraph b. of Condition 2. Duties In the
Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Coach -
don&
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2. With respect to the insurance provided by this endorsement the following are added to Paragraph 2.
b. The following is added to Paragraph b. Excess Insurance:
Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability:
When a written contract or written agreement, other than a promises lease, facilities rental contract or
This insurance does not appry to:
agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political
a. 'Bodily injury' or 'property damago' arising from the sole negligence of the additional insured.
subdivision between you and an additional Insured does not require this insurance to be primary or
primary and non-contributory, this Insurance is excess over any other insurance for which the addi-
b. 'Bodily injury' or 'property damage* that occurs prior to you commencing operations at the
tonal Insured Is designated as a Named Insured.
location where such 'bodily injury' or 'property damage" occurs.
Regardless of the written agreement between you and an additional insured, this insurance is excess
c. "Bodily injury', 'prop" damage' or 'personal and advertising Injury' arising out of the render-
over any other Insurance whether primary, excess, contingent or on any other basis for which the
ing of, or the failure to render, any professional architectural, engineering or surveying services,
additional Insured has been added as an additional insured on other policies.
Including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
1. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
reports, surveys, field orders, change orders or drawings and specifications; or
This provision applies to any person or organization who qualifies as an additional insured under any form
(2) Supervisory. Inspection, architectural or engineering activities.
or endorsement under this policy.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing In
'occur-
1. The following Is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suft:
the supervision, hiring, employment, baining or monitoring of others by that insured. if the
rance' which caused the 'bodily Injury" or 'property damagew, or the offense which caused the
An additional Insured under this endorsement will as soon as practicable:
"personal and advertising Injury", involved the rendering of, or the failure to render. any professional
a. Give written notice of an 'occurrence* or an offense that may result in a claim or 'suit7 under
architectural, engineering or surveying services.
this Insurance to us;
d. 'Bodily Injury' or "prop" damage' occurring after.
b. Tender the defense and Indemnity of any claim or "suit' to all insurers whom also have
(1) All work. including malanals, parts or equipment furnished In connection with such work, on
insurance available to the additional Insured; and
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
c. Agree to make available any other Insurance which the additional insured has for a loss we
additional Insured(s) at the location of the covered operations has been completed; or
cover under this Coverage Part.
(2) That portion of 'your work' out of which the Injury or damage ahses has been put to its
d. We have no duty to defend or Indemnify an additional Insured under this endorsement until
we receive written notice of a 'suir by the additional insured.
Intended use by any person or organization other than another contractor or subcontractor
engaged In performing operations for a principal as a part of the same project.
2. The limits of Insurance applicable to the additional insured are those specified In a written contract
or written agreement or the limits of Insurance as stated in the Declarations of this policy and
9. Any person or organization specrfically designated as an additional insured for ongoing operations
defined In Section III - Limits of Insurance of this policy, whichever are less. These limits are
by a separate ADDITIONAL INSURED -OVVNERS. LESSEES OR CONTRACTORS endorsement Is-
Inclusive of and not in addition to the limits of insurance available under this policy.
sued by us and made a part of this policy.
3. With rasped to the Insurance afforded to these additional insureds, the following Is added to Section III
J. WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS I MALPRACTICE
- Llmfts Of Insurance:
WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
If coverage provided to the additional insured is required by a contract or agreement, the most we will
Paragraph 2.a.(1) of Section 11 -Who Is An Insured is replaced with the following:
pay on behalf of the additional Insured is the amount of insurance:
(1) 'Bodily Injury" or "personal and advertising injury":
a. Required by the contract or agreement; or
b. Available under the applicable Limits of Insurance shown In the Declarations;
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if
you are a -mtm liability company), to a co -'employee" while Iri :1- course of his or her employ -
whichever Is less.
rnor�,, or �,erfomling duties 1`0�3tQa to :hL conduct of your busiress. or to your other 'vo(unteer
This endorsement shall not increase the applicable Limits of Insurance shown in the Declaratio ns.
workers" while performing duties related to the conduct of your business;
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
(b) To the spouse, child, parent brother or sister of that cD-�employee" or "voluntSer worker' as a
This provision applies to any person or organization who qualifies as an additional Insured under any form
consequence of Paragraph (1) (a) above;
or endorsement under this policy.
(c) For which there Is any obligation to share damages with or repay someone else who must pay
damages because of the Injury described In Paragraphs (1) (a) or (b) above; or
Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend-
(d) Ansing out of his or her providing or failing to provide professional health care services. However.
ad as follows:
I' you are not in the business of providing professional health care services or providing profes-
a. The following is added to Paragraph a. Primary Insurance:
sional health care personnel to others, or If coverage for providing professional health care ser-
vices Is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not
If an additional insured's policy has an Other Insurance provision making Its policy excess, and you
apply.
have agreed In a written contract or written agreement to provide the additional Insured coverage on a
primary and noncontributDry basis, this policy shall be primary and we will not seek contribution from
Paragraphs (a) and (b) above do not apply to "bodily injury' or "personal and advertising injury' caused by
the additional insured's policy for damages we cover.
an 'employee' who is acting In a supervisory capacity for you. Supervisory capacity as used herein means
'employ-
the "employea's' job responsibilities assigned by you, includes the direct supervision of other
ees' of yours. However, none of these 'employees" are insureds for 'bodily injury' or "personal and
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advertising injury' arising out of their willful conduct, which Is defined as the purposeful or willful Intent to
cause 'bodily injury" or 'personal and advertising injury, or caused in whole or in part by their Intoxica-
lion by liquor or controlled substances.
The coverage provided by provision J. Is excess over any other valid and collectable Insurance available to
your "employee'.
K. NEWLY FORMED ORADDITIONALLY ACQUIRED ENTITIES
Paragraph 3. of Section 11 - Who Is An Insured is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
Interest, will quality as a Named Insured If there Is no other similar Insurance available to that
organization. However.
a. Coverage under this provision is afforded only unlit the expiration of the policy period In
which the entity was acquired or formed by you;
b. Coverage A does not apply to 'bodily Injury" or 'property damage' that occurred before you
acquired or formed the organization; and
c. Coverage B does riot apply to "personal and advertising Injury' arising out of an offense
committed before you acquired or formed the organization.
d. Records and descriptions at operations must be maintained by the first Named Insured.
No person or organization is an insured with respect to the conduct of any current or past Dannership. joint
vanking or limited liability company that is not shown as a Named Insured in Vie Declarations or qualifies
as an insured under this provision.
L FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre-
sentations:
Your failure to disclose all hazards or prior "occurrences" existing as of the Inception date of the policy
shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or
prior 'occurrences' is not Intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
Under Section IV - Commercial General Liability Conditions, the following Is added to Condition 2. Duties
In The Event of Occurrence, Offens% Ctalm Or Suit
Knowledge of an "occurrence". offense, claim or "suir by an agent, servant or *employee' of any
Insured shall not In ftelf constitute knowledge of the Insured unless an Insured listed under Parag. aph.
1. of Section 11 - Who Is An Insured or a person who has been designated by them to receive reports of
"occurrences', offenses, claims or "suits' shall have received such notice from the agent servant or
"employee".
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without
additional premium charge, your policy will automatically provide the coverage as of the day the revision is
effective in your state.
0. BODILY INJURY REDEFINED
Under Section V - Defintillons, Definition 3. is replaced by the following:
3. 'Bodily Injury- means physical inlury, sickness or dlsk-a�e �-j��Ined by a c(.'scn. This lnd�de�;
mental anguish, mental Injury, sho4�*. fright or death iNi: rcrsu;L, from such phys cal Injury, s,ck-
ness or disease.
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P. EXTENDED PROPERTYDAMAGE
Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the
following:
a. Expected Orkdended Injury
"Bodily Injury' or 'property damage' expected or Intended from the standpoint of the insured.
This exclusion does not apply to "bodily Injury' or mproperty clannagen resuldng from the use of
reasonable force to protect persons or property.
Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8. Trans-
fer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against a person or organizatlon because of payments we
make for Injury or damage arising out of your ongoing operations or 'your worW done under a
contract with that person or organization and Inducied In the 'products -completed operations hazard'
provided:
1. You and that person or organization have agreed In writing in a contract or agreement that you
waive such rights against that person or organization; and
2. The Injury or damage occurs subsequent to the execution of the written contract or written agree-
ment.
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b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage
from automatic fire protection systems to premises while rented to you or temporarily occupied by
you with permission of the owner. A separate limit of insurance applies to Damage To Premises
Rented To You as described in Section III - Limits Of Insurance.
2. Paragraph 6. under Section III - Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 6. above, the Damage To Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of "property damage" to:
a. Any one premise:
(1) While rented to you; or
(2) While rented to you or temporarily occupied by you with permission of the owner for
damage by fire, lightning, explosion, smoke or leakage from automatic protection sys-
tems; or
b. Contents that you rent or lease as part of a premises rental or lease agreement.
3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO
YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following:
9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporarily
occupied by you with the permission of the owner, or for damage to contents of such premises
that are included in your premises rental or lease agreement, is not an "insured contract'.
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy
are amended as follows:
Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph
(b) of Paragraph a. is replaced by the following:
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
I . Under Supplementary Payments - Coverages A and B, Paragraph I.b. is replaced by the following:
b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have
to furnish these bonds.
2. Paragraph I.d. is replaced by the following:
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or
defense of the claim or "suit", including actual loss of earnings up to $600 a day because of time
off from work.
1. Paragraph 2. under Section 11 - Who Is An Insured is amended to include as an insured any person or
organization whom you have agreed to add as an additional insured in a written contract, written
agreement or permit. Such person or organization is an additional insured but only with respect to
liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole
or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided that the "bodily injury" or "property damage" occurs, or the "per-
sonal and advertising injury" is committed, subsequent to the signing of such written contract or
written agreement; or
0 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8
b. Premises or facilities rented by you or used by you; or
c. The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or
d. Operations performed by you or on your behalf for which the state or political subdivision has
issued a permit subject to the following additional provisions:
(1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad-
vertising injury" arising out of the operations performed for the state or political subdivision;
(2) This insurance does not apply to "bodily injury" or "property damage" included within the
"completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this insurance.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insur-
ance afforded to such additional insured will not be broader than that which you are required by
the contract or agreement to provide for such additional insured.
With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured
under this endorsement ends when:
(1) All work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project.
With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured
under this endorsement ends when their written contract or written agreement with you for such
premises or facilities ends.
With respects to Paragraph I.c. above, this insurance does not apply to any "occurrence" which takes
place after the equipment rental or lease agreement has expired or you have returned such equipment
to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement
is signed prior to the "bodily injury" or "property damage".
We have no duty to defend an additional insured under this endorsement until we receive written
notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the
Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi-
tions.
0 2013 Liberty Mutual Insuranoe
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8
_�1111111N SPEEWES-01 AMICHEL
'144c"R", DATE (MMIDDIYYYY)
�%� CERTIFICATE OF LIABILITY INSURANCE F 03/09/2018
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(les) 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 COMT
NA E�CT
Hub International Northwest LLC iPHONE FAX
12100 NE 195th Street, Suite 200 (A/C, No Ext): (425) 489-4500 Wc. No):(425) 485-8489
Bothell, WA 98011 now.info@-hubinternational.com
RECE- __ INSURERIS1 AFFORDING COVERAGE NAIC #
IVED - Wpqt Amprirnn Inwirani-a ('n 1AA'AQ-A
INSURED Edmonds 2020, LLC MAR 12 29N
307 Bell Street E1V0N,%:p1NG
Edmonds, WA 98020 —1
2
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.
ADDLSUBR
JNSD
LIMITS SHOWN MAY HAVE BEEN
J"A POLICY NUMBER
REDUCED BY
POLICY EFF
1MMJDDIYYYY1
PAID CLAIMS.
POLICY EXP
I JMfiXUVVM
LIMITS
OCCURRENCE $ 1,000,000
INSR
LTR,
TYPE OF INSURANCE
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE EX:] OCCUR
X
X
BKW54732230
03/10/2018
03/1 012019
_F�Chi
DAMAGETORENTED $ i,000,000
-PREMISES (Ea Qccurrerce)
AELD EXP (My one person) $ 16,000
PERSONAL & ADV INJURY 8 1,000,000
GEWL AGGREGATIE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
POLICY LXj Yp&- L -1 LOC
PRODUCTS - CQMP/OPAGG S zo-00,000
OTHIEW
$
ONIBINED SINGI F I IMIT 1,000,000
_0=1) $ —
B AUTOMOBILE LIABILITY
ANY AUTO
BAA64732230
03/1012018
03/10/2019
BODILY INJURY ff�erp soqL $
qL_
OWNED SCHEDULED
BODI IN -JURY LP
AUTOS ONLY AUTOS
N
01'0% ONLY ARNIS
$
_30r
EACH OCCURRENCE
$
$
UMBRELLA LIAB
HCLAIMS-MADE
OCCUR
AGGRE ' 3ATE
$
EXCESS LIAB
DIED I I RETENTION$
$
A
WORKERS COMPENSATION
TH-
F0_R
AN 0 EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE
F
NIA
BKW54732230
03/10/2018
03/1012019
E-L. EACH ACP,1DEN T
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE!
$ 1,000,000
Wa`n'�SEP'rM
n
0 y5M�ff)
Ifrs describe under
I
E.L. DISEASE - POLIQv IMIT
.1� 1,000,000
D RIPTION OF OPERATIONS below
S6
BKW6_4732230 103MO12018
A I
Equipment Floater
03MO120191LImit:
300,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aftached If more space Is required)
Re: E-26 Encroachment Permit
It Is understood and agreed that the City of Edmonds Is an additional Insured per attached form cg8810 0413 where required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Edmonds Engineering Division ACCORDANCE WITH THE POLICY PROVISIONS.
121 6th Avenue North
EDMONDS, WA 98020
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
2. With respect to the insurance provided by this endorsement the following are added to Paragraph 2.
b. The following is added to Paragraph b. Excess Insurance:
Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability:
When a written contract or written agreement, other than a promises lease, facilities rental contract or
This Insurance does not apply to:
agreement, an equipment rental or lease contract or agreement, or permit Issued by a state or political
a. "Bodily Injury' or "property damage" arising from the sole negligence of the additional Insured.
subdivision between you and an addItIonal Insured does not require this Insurance to be primary or
primary and non-contributory, this Insurance Is excess over any other insurance for which the addl-
b. 'Bodily Injury" or 'prop" damage' that occurs prior to you commencing operations at the
tonal Insured Is designated as a Named Insured.
location where such 'bodily Injury' or 'property damage" occurs.
Regardless of the written agreement between you and an additional insured, this Insurance is excess
c. "Bodily Injury', 'property damage" or 'personal and adverUslng Injury' arising out of the render-
over any other Insurance whether primary, excess, contingent or on any other basis for which the
Ing of, or the failure to render, any professional architectural, engineering or surveying services,
additional Insured has been added as an addltional insured on other policies.
Including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
1. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR 'LIMITS OF INSURANCE"
reports, surveys, field orders, change orders or drawings and specificallons; or
This provision applies to any person or organization who qualifies as an addIflonal Insured under any form
(2) Supervisory, Inspection, architectural or engineering activities.
or endorsement under this policy.
This exclusion applies even if the claims against any Insured allege negligence or other wrongdoing In
1 . The following Is added to Condition 2. Duties In The Event Of Occurrence, Offense, Ciaim or Suit:
the supervision, hiring, employment training or monitoring of others by that insured, if the 'occur-
rence" which caused the "bodily Injury' or 'property damage', or the offense which caused the
An additional Insured under this endorsement will as soon as practicable:
"personal and advertising Injury", involved the rendering of, or the failure to render. any professional
a. Give written notice of an "occurrence" or an offense that may result In a claim or 'sutr under
architectural, engineering or surveying services.
this Insurance to us;
d. "Bodily injury' or 'property damage' occurring after.
b. Tender the defense and Indemnity of any claim or "suit' to all insurers whom also have
(1) All work, Including materials, parts or equipment furnished In connection with such work, on
Insurance available to the additional Insured; and
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
c. Agree to make available any other Insurance which the additional Insured has for a loss we
additional Insured(s) at the location of the covered operations has been completed; or
cover under this Coverage Part.
(2) That portion of 'your worW' out of which the Injury or damage arises has been put to Its
d. We have no duty to defend or Indemnify an additional Insured under this endorsement until
"suir
intended use by any person or organizabon other than another contractor or subcontractor
we receive written notice of a by the additional insured.
engaged in performing operations for a principal as a part of the same project.
2. The limits of Insurance applicable to the additional Insured are those specified In a written contract
or written agreement or the limits of Insurance as stated in the Declarations of this policy and
a. Any person or organization specifically designated as an additional Insured for ongoing operations
defined in Section III - Limits of Insurance of this policy, whichever are less. These limits are
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is-
inclusive of and not in addition to the limits of Insurance available under this policy.
sued by us and made a part of this policy.
3. With rasped to the Insurance afforded to these additional insureds, the following Is added to Section III
J. WHO 13 AN INSURED - INCIDENTAL MEDICAL ERRORS I MALPRACTICE
- Limits Of Insurance:
WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
If coverage provided to the additional insured is required by a contract or agreement, the most we will
Paragraph 2.a.(1) of Section 11 -Who Is An Insured is replaced with the following:
pay on behalf of the additional Insured Is the amount of insurance:
(1) 'Bodily Injury" or "personal and advertising injury":
a. Required by the contract or agreement; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
(a) To you, to your partners or members (if you am a partnership or joint venture), to your members (if
you are a limited liability company), to a co-�errnployee" while In the course of his or her employ -
whichever Is less.
ment or performing duties related to the conduct of your business, or to your other 'volunteer
This endorsement shall not Increase the applicable Lirnits of Insurance shown In the Declarstio, ns.
woekers" while performing duties related to the conduct of your business:
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
(b) To the spouse, child, parent, brother or sister of that co -'employee" or 'volunteer workee as a
This provision applies to any person or organization who qualifies as an additional Insured under any form
consequence of Paragraph (1) (a) above;
or endorsement under this policy.
(c) For which there Is any obligation to share damages with or repay someone else who must pay
damages bemuse of the Injury described in Paragraphs (1) (a) or (b) above; or
Condition 4. Other Insurance of SECTION TV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend-
(d) Arising out of his or her providing or failing to provide professional health care services. However,
ed as follows:
If you are not in the business of providing professional health care services or providing profes-
a. The following is added to Paragraph a. Primary Insurance:
sional health care personnel to others. or if coverage for providing professional health care ser-
vices Is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not
If an additional insured's policy has an Other Insurance provision maldng Its policy excess, and you
apply.
have agreed In a written contract or written agreement to provide the additional Insured coverage on a
primary and noncontributDry basis. this policy shall be primary and we will riot seek contribution from
Paragraphs (a) and (b) above do not apply to 'bodily Injury" or 'personal and advertising Injury' caused by
the additional insured's policy for damages we cover.
an 'employee" who is acting In a supervisory capacity for you. Supervisory capacity as used herein means
the 'employee's' job responsibilities assigned by you, Includes the direct supervision or other 'employ-
ees' of yours. However, none of these 'employees" are Insureds for 'bodily injury' or 'personal and
0 2013 Liberty Mutual Insurance 0 2013 Liberty, Mutual Insuran-
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with Ito permission. Page 5 of 8 CG 60 110 04 13 Includes copyrighted material of Insurance Servlm Office, Inc., with Its permission. Page 6 of 8
advertising injury' arising out of their Wilful conduct, which Is defined as the purposeful or Witful Intent to
P. EXTENDED PROPERTY DAMAGE
cause 'bodily injury' or 'personal and advertising injury, or caused in whole or in part by their intoxica-
Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the
bon by liquor or controlled substances.
following:
The coverage provided by provision J. Is excess over any other valid and collectable Insurance available to
a. Expected Or Intended Injury
your "employee".
K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
"Bodily injury' or "property damage' expected or intended from the standpoint of the insured
This exclusion does not apply to 'bodily Injury" or 'property damage" resulting from the use of
Paragraph 3. of Section 11 -Who Is An Insured is replaced by the following:
reasonable force to protect persons or property.
3. Any organization you newly acquire or form and over which you maintain ownership or majority
Interest, will qualify as a Named Insured If there Is no other similar Insurance available to that
Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
organizabon. However.
CONTRACT OR AGREEMENT WITH YOU
a. Coverage under this provision Is afforded only until the explrabon of the policy period In
Under Section IV - Commercial General Liability Conditions, the following Is added to Condition 8. Trans -
which the entity was acquired or formed by you;
fer Of Rights Of Recovery Against Others To Us:
b. Coverage A does not apply to 'bodfly Injury' or "property damagV that occurred before you
We waive any night of recovery we may have against a person or organization because of payments we
acquired or formed the organization; and
make for Injury or damage arising out of your ongoing operations or 'your work' done under a
'products
c. Coverage 8 does not apply to 'personal and advertising Injury' arising out of an offense
contract with that person or organization and Included In the -completed operations hazard"
committed before you acquired or formed the organization.
provided:
d. Records and descripflons of operations must be maintained by the first Named Insured.
1. You and that person or organization have agreed in writing in a contract or agreement that you
waive such rights against that person or organization; and
No person or organization Is an Insured with respect to the conduct of any current or past partnership, joint
venture or llmIted liability company that is not shown as a Named Insured In the Declaraltions or qualifies
2. The Injury or damage occurs subsequent to the execution of the written contract or written agree -
as an Insured under this provision.
ment.
L FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre-
sentations:
Your failure to disclose all hazards or prior 'occurrences" existing as of the Inception date of the policy
shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or
prior 'occurrences' is not intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
Under Section IV - Commercial General Liability Conditions, the following Is added to Condition 2. Duties
In The Event of Occurrence, Offens% Claim Or Suit:
Knowledge of an "occurrence", offense, claim or 'suit' by an agent, servant or "employee" of any
Insured shall not in Itself constitute knowledge of the insured unless an Insured listed under Paragraph
1. of Section 11 - Who Is An Insured or a person who has been designated by them to racelve reports of
"occurrencee, offenses, claims or 'suits' shall have received such notice from the agent, servant or
"employee".
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without
dditional premium charge, your policy will automatically provide the coverage as of the day the revision is
ffective in your state.
0. BODILY INJURY REDEFINED
Under Section V - Definitions, Definition 3. Is replaced by the following:
3. -Bodily Injury' means physical intury, sk*ness or disease sj�'zlnadl by a person. This Includes
mental anguish, mental Injury, shock. fright or death hat resull— from such physical Injury, sick-
ness or disease.
2013 Liberty Muluel Insurance
0 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes ocipyrIghted rnat8dal of Insurance Services Offics, Inc.. with Its permission. Page 7 of 8
CG 88 10 04 13 Includes copyrighted rnaterlal of Insurance Servims Offica, lnc,with its permission. Page 8 of 8