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CERTIFICAl"E OF LIAMLITYANISURAN'C"t _F�
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R-HS CERTIFI(.',,A'Frn N VESUIEE) AS A IWAII OF 6Pi'u{Il"ORMA'110114 OV4,Y AMD MO RK3,'iTl8,jP0fl
CA_',.'RTIFK.',,ATE DOE',$ N10F AFFlRIV1ATIIVE1,.V' OR NEGATIVELY AMEND:, EX -TEND OR AL.'FETZ 'RiE. COVERAGE AI IFORDED Hy "I"HE
BELOW. THIS G11IR"t"NRCATE OF INSURANCE LPOF-S MfCUf G0Pd8'f1VJTE A f,ONTRACT BETWEEN 1HE ISSUINC; PISLIRII
I'REPRESENTATIIV�,'-,-,', q'.J1,R ANDTIff CIEF,1TIRCATE HOMER.
IWIPORTANTR, ffie certfficafe L*Idw- Is avI AD DITiONA11- INSURED, We pok!p�(iv,!G) 114 v41sN: �,ie Ginrkasod,. If SU8R(JGJ.%"T"�CN IS WAWED,
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RODUCER 425-489-4500' NAME�
H1W) kAaI'nnfionIA NVVAMO;r '�jUld[NE X
PO Box 3018 425, 1180-4501 (A/C, No,E,d..:
Bofl-Ic-H, MVO D8041 43MS L-MAIC",
Fiefin _ADDRESS;
INSURER(S) AFFORDING COVERAOE NAM
INSURER A ; Continental CasuiRy Co 20443
MISUPIrD TtIe wishhll� mwfP„1'4RF,3 INS, I JRE_RB':
javlat Y0S111Uravva
623 M,.'4lU INSURER C�
Edniolmls, WA 99020, INSURER D
LN iUbER E:
__.INSURER F:
G 0 V F. R A G' Ef, S CEWHICATE INUMBEHR: RE-VISM NUMBER:
THS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW FIAVE BEEN ISSUED "TO THE INSURED NAMED ABOVE I -OR THE PO1ICY PERIOD
1,1DICATED, NoTwiTiTSTAMIDING AINY REQUIREMENT, TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC11 THIS
CERI-IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 1-0 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, WAITS SHOWN MAY HAVE BEEII REDUCED BY PAID CLAIMS.
INSR An _DL SM—L, R
LTR TYPE OF INSURANCE KSR VVVD OLICYNUMBER POLICY EFF POLICY FKP Ll M D"S
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL UASID IY
6094590203
1, 81
EACHOCCURRIENCE
U AMAGE IQ H ENTE D
IPREMIS�S
$ 4,000,000
300,11W
CLAIMS -MADE occur,
MEDEXPIAnyonppersupI
$ 10,000
41
PERSONAL & ADV I[1$jUl y_
2,000,000
. .....
GENERALAGGRIEGATE
4,000,000
PR OCLC I S
$ 2,000,000
GENT
AGGREGATE 1.11AITAPPLIES PER:
F-1 31]"Ioi Lbac
$
AUTOMOBILE
LIABILITY
LIMIT
i,000,000
BODILY INJURY (Per person)
s
A
ANY AUTO
5094590203
09/18/14
ALLOWNED SCHEDULED
AUTOS AUTOS
X WIN -OWNED
HIREDAUTOS AUTOS
X
BODILY INJUFW(P I ..ddant)
—DAMAGE
$
pROPrqj y
$
X
UMBRELLA LIAR
rACH OCCUERRENCE
A
!�LAl MU
EXCESSLIAB'CLAIMS
S_M�DE
91
AGGREGAT
1,G0,001� 00
IDED
RETENTION$ 100110
WORKERS COMPENSATION
Ts—TA—Ty-T—T-5TH
W'
MTORY TIM11S
AND EMPLOYERS" LIABILITY YIN
LL F_R_
A
ANY PROPRIETOWPARTNERIEXECUTIVE
OrF,CLRIMFMHER EXCLUDED?
NdA
5094590203
6118
091101141
E.L. EACH ACCIDEN I'
_EA
$
(Mat Idatory in Nil)
STOP GAP
E L DISEASE EMP_L(')4YEF
1,04. 00',000
I f yes, describe under
DESCRIPTION OF OPERACrIONS below
1, D S
SEABE S 2,000',0100
POLICY LIMIT
A
IProperty
5094590203 A
01911,31,13 T�
09118/14
PROPERTY 30,0400
DESCRIPTION OF OPERATIONS I LOCATIONS IVLHICLES (Attach ACORD 101, Additional Remarks Schedule, ii'more space is s required)
It is understood and agreed that the City of Edmonds is namedas an,
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additional insured for th located at p
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Edmonds, WA 98020 in thetr'�Tty right-of-way, COVGrage :LS pri-mary aiid"'non-
contributory , I'll, . .
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4'.3EKNIFICATE HOLDER
CANCELLATI10M
S SHOUIDANYOFTHEABOVIE DESCRIBED POI-ICII,,SSE('AVI:G[ZI.L.EDBEr-,ORE
(Afy (,,24 Ednioncls
THE EXPIRA110H DATE THEREOF, NOTICE WILL BE DEI.IVERED IN
ACCORDANCE WfI POLICY PROVISNOI40,
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A f'TVii N/,ra N1
_LL
AUTI IOR1ZEP RF11RESEW FATIVE
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