Orca Land Surveying Inc. 9/4/2020

A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/9/2020 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(ies)must 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 CONTACT CLC3 NAME: Leavitt Group Northwest (A/C,No,Extl: (800)726 8771 FAX c,NO): (866)728-9168 PO Box 65770 E-MAIL Broker ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# University Place WA 98464 INSURER A:Travelers Indemnity Company of CT 25682 INSURED INSURER B:Phoenix Insurance Company 25623 Orca Land Surveying, Inc. INSURERC: 3605 Colby Ave INSURER D: Debbie Schols INSURER E: Everett WA 98201 INSURER F: COVERAGES CERTIFICATE NUMBER:19/20 Master 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTE A CLAIMS-MADE X OCCUR PREMSESO(Ea ocurrence) $ 1,000,000 X General Liability X Y 6804H989543 12/2/2019 12/2/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER-. GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG 5 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S B ALL OWNED SCHEDULED _ AUTOS _ AUTOS X BA2797p509 12/2/2019 12/2/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) UIM UM $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER STATUTE X OTRH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE WA Stop Gap E L EACH ACCIDENT 5 1,000,000 OFFICERiMEMBER EXCLUDED? N I A A (Mandatory in NH) 6804H989543 12/2/2019 12/2/2020 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Everett, its officers, employees and agents are named additional insured with respects to general liability per form CGD3810915, primary and non-contributory form CGD7970116, waiver of subrogation form CGD3790106, auto liabilty form CAT4200215. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 2930 Wetmore Ave Ste 8-A ACCORDANCE WITH THE POLICY PROVISIONS. Everett, WA 98201 AUTHORIZED REPRESENTATIVE �, j/��.�,, � FT a.Gilmer/PJGILM 6„""--- �' I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)