HWA Geosciences Inc. 12/13/2021 - Laserfiche WebLink

1 ® GATE{MM/DD/YYYY) C ACØRD® CERTIFICATE OF LIABILITY INSURANCE 2/02/2021 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(les)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 CONTACT Orion Insurance/Ralph Taylor NAME: Orion Insurance Group PHONE Extr (425)771-5197 FAX No): (425)673-4427 10634 E.Riverside Dr. E-MAIL rtaylor@orioninsgroup.com ADDRESS: Suite#300 INSURERS)AFFORDING COVERAGE NAIC 0 Bothell WA 98011 INSURER A: Travelers Insurance Company 36137 INSURED INSURER B: Kinsale Insurance Company 38920 HWA GeoSciences Inc. INSURER C: 21312 30th Drive SE,Suite 110 INSURER 0: INSURER E: Bothell WA 98021-7010 INSURER F: COVERAGES CERTIFICATE NUMBER: CL19112604262 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 ADOLSUBR POUCY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/OD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000,000 DAMAGE TO RENTED CLAIMS-MADE XI OCCUR PREMISES Ea occurrence) S 1,000,000 MED EXP(Any one person) S 10,000 A Y Y 680-009N931138-19 47 12/01/2021 12/01/2022 PERSONAL BADVINJURY S 1,D00,000 GEN'LAGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE S 2,000,000 POLICY X JECT LOC 2.00000 OTHER. 5 AUTOMOBILE UABILITY COMBINED SINGLE LIMIT 5 1,000.000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED Y Y BA-3P900632-19-GRP 12/01/2021 12/01/2022 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE 5 X AUTOS ONLY X AUTOS ONLY (Per accident) S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS LIAB CLAIMS-MADE Y Y CUP-003P901597-19-47 12/01/2021 12/01/2022 AGGREGATE S 5,000,000 DED RETENTION 5 5 WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 1 A ANY PROPRIETOR/PARTNER/EXECUTIVE N IA Y 680-009N931138 STOP GAP 12/01/2021 12101/2022 E.E.L.EACH ACCIDENT 5 , , OFFICE EXCLUDED 10 ,00000 (Mandatory In In NH)NH) E.L.DISEASE-EA EMPLOYEE 5 , II yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , $3,000,000 Each Claim $75,000 Professional Liability Claims Made B Including Pollution Liability 0100171187-0 12/01/2021 12/01/2022 $3,000,000 Aggregate Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Full Prior Acts for 3m/3m limits.Excess Professional Liability limits of 2m/2m limits over primary professional liability policy-retro date 12/1/2020 through Navigators,Policy#CE21MPLZ071641C. All required parties are listed as additional insureds with primary non-contributory wording except with respect to professional liability and worker's compensation. 30-days notice of cancellation modification applies to certificate holder. A blanket waiver of subrogation applies in favor of additional insureds for all policies,excluding professional and pollution. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. 3200 Cedar St AUTHORIZED REPRESENTATIVE , Everett WA 98201 ‘—J4^'"k` \'`t'� I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD