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Client#: 53352 OTAKINC
<br /> ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)10/09/2019
<br /> ITHIS 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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER ACT Carly Underwood
<br /> Greyling Ins. Brokerage/EPIC PHONE 770.552.4225 FAX 866.550.4082
<br /> (A/C,No,Ext): (A/C,No):
<br /> 3780 Mansell Road,Suite 370 ADDRess: carly.underwood@greyling.com
<br /> Alpharetta,GA 30022 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:The Phoenix Insurance Company 25623
<br /> INSUREDINSURER B:Travelers Indemnity Company 25658
<br /> Otak, Inc.
<br /> INSURER C:Beazley Insurance Company,Inc. 37540
<br /> 808 SW Third Avenue,Suite 300 INSURER D:Travelers Indemnity Company of America 25666
<br /> Portland,OR 97204
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 19-20 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 ADDL SUBR POLICY EFF POLICY EXP W /YLIMITS
<br /> LTR INSR, VD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 6805H2424691947 01/01/2019 01/01/2020 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR
<br /> DAMAGE
<br /> O(Ea RENTED
<br /> ence) $1,000,000
<br /> MED EXP(Any one person) _$5,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$2,000,000
<br /> PRO-
<br /> POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY BA1502P89218GRP 01/01/2019 01/01/2020 COMBIaccideNEDnt)SI $NGLE LIMIT 1,000,000
<br /> {Ea
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> HIRED N -OWNED PROPERTY DAMAGE $
<br /> X AUTOS ONLY X AUTOS ONLY (Per accident)
<br /> $
<br /> B X UMBRELLA LIAB X OCCUR CUP5C8570811847 01/01/2019 01/01/2020 EACH OCCURRENCE $10,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
<br /> DED X RETENTION$10000
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE FR
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $
<br /> C Professional V10267191001 01/01/2019 01/01/2020 Per Claim$2,000,000
<br /> Liability Aggregate$4,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett, its officers,employees and agents are named as Additional Insureds with respects to
<br /> General&Automobile Liability where required by written contract.The above referenced liability policies
<br /> with the exception of workers compensation and professional liability are primary&non-contributory where
<br /> required by written contract.Waiver of Subrogation is applicable where required by written contract&
<br /> allowed by law.Should any of the above described policies be cancelled by the issuing insurer before the
<br /> (See Attached Descriptions)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cit of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 3200 Cedar Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> #S1820326/M1427234 J N OY1
<br />
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