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' ' 8 <br /> A`c)RD© CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br /> 2/28/2014 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> • PRODUCER UNICO Group, Inc. NAME CT UNICO Group,Inc. <br /> O Street E-MAIIJ.Ext): 402-434-7200 FAX,No): 402-434-7272 <br /> Lincoln, NE 68510 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC <br /> _ INSURER A: Charter Oak Fire Insurance Corn.any <br /> INSURED INSURER B: <br /> Seattle-DLR Group inc. <br /> 901 Fifth Avenue, Suite 700 INSURER C: <br /> Seattle WA 98164-1006 INSURERD: Travelers Indemnity Company <br /> INSURER E: Travelers Casualty Insurance Co.of America <br /> INSURER F: I <br /> COVERAGES CERTIFICATE NUMBER: 19372430 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POUCIES 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. <br /> �LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE IINSD ISWVD I POLICY NUMBER (MMIDDJYYYYY) (EFF MM/DDIYYYY)I - LIMITS <br /> A ✓ COMMERCIAL GENERAL LIABILITY 630-9185N623-COF-13 10/1/2013 10/1/2014 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RD <br /> CLAIMS-MADE ✓ OCCUR PREMISES(Es oc urrrence) $ 300,000 <br /> MED EXP(Any one person) $ 10,000 <br /> • PERSONAL&ADV INJURY $ 1,000,000 . <br /> GEHLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> ✓ POLICY ✓ ja I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY 810-9185N623-TIL-13 10/1/2013 10/1/2014 (CEaa=INGLELIMIT $ 1,000,000 <br /> ✓ ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOVJNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS • <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIREDAUTOS AUTOS (Per accident) <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE• <br /> $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> D WORKERS COMPENSATION UB-9185N623-13 10/1/2013 10/1/2014 / STATUTE I <br /> E AND EMPLOYERS'LIABILITY YIN UB-0161P573-13 CA Only <br /> ANY PROPRIETOR/PARTNER/EXECUTIVENIA EL EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) EL DISEASE.-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below - EL DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE: Everett Public Works Study;DLR Project#73-14152-00 <br /> Certificate Holder is an Additional insured with respects the operations of the named insured under the Commercial General Liability <br /> and Business Auto coverage,as required by written contract(CGD4140400;C000370405;and CAT3530310). <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 /> 73-14152-00 - <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Everett 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 /> (LIN)Tom Champoux <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> CERT NO.: 19372430 CLIENT CODE: 3299 (LIN) Mardi :Ilam 2/28/2014 8:48:53 LM ea49 of 1 <br />