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ACC�►1D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/rYYY) <br /> 4/18/2016 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER UNICO Group, Inc. NAMEACT UNICO Group,Inc. <br /> 1128 Lincoln Mall PHONE FAX <br /> Suite 200 (A/C.No.Ext): 402-434-7200 (A/c,No): 402-434-7272 <br /> Lincoln, NE 68508 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Charter Oak Fire Insurance Company <br /> INSURED INSURER B: United Specialty Insurance Co. <br /> Seattle- DLR Group inc. <br /> 51 University Street, Suite 600 INSURER c: Travelers Property Casualty Co.of America <br /> Seattle WA 98101-3614 INSURER D: Travelers Indemnity Company <br /> INSURER E: The Phoenix Insurance Co. <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 29505900 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 /> INSR TYPE OF INSURANCE W <br /> ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> A / COMMERCIAL GENERAL UABILITY 630-9185N623-COF-15 10/1/2015 10/1/2016 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RETED <br /> CLAIMS-MADE / OCCUR PREMISES(Ea occurrence) $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> / POLICY / jECT ✓ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> E AUTOMOBILE LIABIUTY 810-9185N623-PHX-15 10/1/2015 10/1/2016 OMBINEDISINGLE LIMIT $ 1,000,000 <br /> ✓ ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY _ AUTOS ONLY (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> D WORKERS COMPENSATION UB-9185N623-IND-15 10/1/2015 10/1/2016 ,/ PER H <br /> STATUTE ET <br /> C AND EMPLOYERS'LIABILITY Y/N UB-0161 P573-15 CA Only <br /> ANYPR PRIETOREXCLUDEE?ECUTIVE N N/A E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICE(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 /> B Architects&Engineers 33USA4103341 10/1/2015 10/1/2016 Each Claim:$1,000,000 <br /> Professional Liability Aggregate:$1,000,000 <br /> Claims-Made Frm Deductible:$25,000(Each Claim) <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE: Everett PW Master Plan;DLR Project#73-16128-00 <br /> Certificate Holder&Others are Additional Insureds with respects the operations of the named insured under the Commercial General Liability coverage <br /> and Business Auto coverage as required by written contract(forms CGD4140408,CGD0370405 and CAT3530215). <br /> Employers Stop Gap Liability,if applicable,provided under Workers Compensation coverage.*Workers Compensation <br /> coverage is not applicable under this policy for State of Washington;Ohio or other monopolistic states. <br /> CERTIFICATE HOLDER CANCELLATION <br /> 73-16128-00 <br /> Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn: Chris Lark ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3101 Cedar Street <br /> Everett WA 98201 <br /> AUTHORIZED REPRESENTATIVE <br /> I (LIN)Robert L.Reynoldson <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />