2021/12/08 Council Agenda Packet

ACORE) CERTIFICATE OF LIABILITY INSURANCE kam...../' DATE(MMIDDIYYYY) 10/25/2021 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 have ADDITIONAL INSURED provisions or 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 I Orion Insurance Group 10634 E Riverside Dr Suite #300 Bothell WA 98011 NAME CT Christopher Day PHONE (425) 771-5197 FAX (425) 673-4427 (A/C. No. Ext1: (A/C, No): E-MAIL chrisday@orioninsgroup.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA: RLI Insurance INSURED 2812 Architecture Inc 2812 Colby Ave Everett WA 98201 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CL218906841 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. ILTR TYPE OF INSURANCE ADDLO SUBR WVD POLICY NUMBER POUCY EFF (MMlDD/YYY)r') POUCY EXP (MMIDO/YYYY) LIMITS A X COMMERCIAL GENERALUABILI1Y Y Y PSB0003093 08/16/2021 08/16/2022 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE l' OCCUR DAMAGE PREMISESO(EENTED occurrence) $ 1,000,000 X Hired Non -Owned Auto Limits MED EXP (Any one person) S 10,000 E Follow General Liability PERSONAL BADV INJURY $ 2.000,000 GEM_ AGGREGATE LIMIT APPLIES PER: POLICY X ERCaT LOC OTHER: GENERAL AGGREGATE S 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 $ AUTOMOBILE - - _ UABIUTY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY - _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ S UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED RETENTION S S A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below 1 NIA Y PSB0003093 08/16/2021 08/16/2022 PER STATUTE OTH- ER Stop Gap E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 A Professional Liability Claims Made Y RDP0041181 09/27/2020 09/27/2022 $2,000,000 Each cCaim $2,000,000 Aggregate $10,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) All required parties are listed as additional insureds with primary and non contributory wording as well as a waiver of subrogation in their favor for the general liability policy. 1 CERTIFICATE HOLDER CANCELLATION City of Everett 3200 Cedar Street Everett I WA 98201 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .416I J ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD