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<br /> AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 08/03/2022
<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 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 rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Kim Grahn
<br /> NAME:
<br /> Shipley&Pease Insurance PHONE (206)519-5371 FAX (503)282-3345
<br /> (A/C,No,Ext): (A/C,No):
<br /> P 0 Box 928 E-MAIL kim@shipleyins.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC H
<br /> Woodinville WA 98072 INSURER A: RLI Corporation
<br /> INSURED INSURER B:
<br /> Botesch Nash&Hall Architects PS INSURER C:
<br /> 2727 Oakes LLC INSURER D:
<br /> 2727 Oakes Ave Ste 100 INSURER E:
<br /> Everett WA 98201 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL219202544 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 ADM_SUUR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 1,000,000
<br /> CLAIMS-MADE XI OCCUR PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y PSB0009013 09/01/2021 09/01/2022 PERSONAL&ADVINJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: Employee Benefits $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A - OWNED SCHEDULED Y Y PSA0002949 09/01/2021 09/01/2022 BODILY INJURY(Per acddent) $
<br /> , AUTOS ONLY _ AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> - AUTOS ONLY AUTOS ONLY (Per accidem)
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2.000,000
<br /> A - EXCESS LIAB X CLAIMS-MADE Y Y PSE0004483 09/01/2021 09/01/2022 AGGREGATE $ 2,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION PER orH- WA Stop Gap
<br /> AND EMPLOYERS'LIABILITY Y/N STATUTE X ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> A OFFICER/MEMBER EXCLUDED? N/A PSB0009013 09/01/2021 09/01/2022
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ,
<br /> Each Claim $2,000,000
<br /> Professional Liability
<br /> A RDP0044641 09/01/2021 09/01/2022 Aggregate $4,000,000
<br /> Deductible $10,000
<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 and employees are Additional insured per PPB304 02/12 and PPA300 03/13 attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Everett Parks&Facilities ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 802 E.Mukilteo Blvd Bldg 100
<br /> AUTHORIZED REPRESENTATIVE ._I,
<br /> Everett WA 98203 Y
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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