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<br />
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />11/16/2022
<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
<br />Willis Towers Watson Midwest, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />Nashville, TN 372305191 USA
<br />CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 (A/C, No, Ext):
<br />FAX 1-888-467-2378 (A/C, No): E-MAIL certificates@willis.com ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A : Liberty Mutual Fire Insurance Company 23035
<br />INSURED
<br />HDR Engineering, Inc.
<br />1917 South 67th Street
<br />Omaha, NE 68106
<br />INSURER B : Ohio Casualty Insurance Company 24074
<br />INSURER C : Liberty Insurance Corporation 42404
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: W26698720 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
<br />LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
<br /> CLAIMS-MADE OCCUR
<br /> DAMAGE TO RENTED
<br />$ 1,000,000 PREMISES (Ea occurrence)
<br />A Contractual Liability MED EXP (Any one person) $ 10,000
<br /> Y Y TB2-641-444950-032 06/01/2022 06/01/2023 PERSONAL & ADV INJURY $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 4,000,000 JECT
<br /> $
<br />
<br /> OTHER:
<br />
<br />
<br />A
<br />AUTOMOBILE LIABILITY
<br />
<br />Y
<br />
<br />
<br />Y
<br />
<br />
<br />AS2-641-444950-042
<br />
<br />
<br />06/01/2022
<br />
<br />
<br />06/01/2023
<br />COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000
<br /> ANY AUTO BODILY INJURY (Per person) $
<br /> OWNED
<br />AUTOS ONLY
<br />HIRED
<br />AUTOS ONLY
<br /> SCHEDULED
<br />AUTOS
<br />NON-OWNED
<br />AUTOS ONLY
<br />BODILY INJURY (Per accident) $
<br /> PROPERTY DAMAGE (Per accident) $
<br /> $
<br />B UMBRELLA LIAB
<br />EXCESS LIAB
<br /> OCCUR
<br />CLAIMS-MADE
<br />
<br />Y
<br />
<br />Y
<br />
<br />EUO(23)57919363
<br />
<br />06/01/2022
<br />
<br />06/01/2023
<br />EACH OCCURRENCE $ 5,000,000
<br /> AGGREGATE $ 5,000,000
<br /> DED
<br /> RETENTION $ 0 $
<br />
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE No
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under DESCRIPTION OF OPERATIONS below
<br />
<br />
<br />
<br />N / A
<br />
<br />
<br />Y
<br />
<br />
<br />WA7-64D-444950-012
<br />
<br />
<br />06/01/2022
<br />
<br />
<br />06/01/2023
<br /> PER STATUTE OTH- ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate Holder is named as Additional Insured on General Liability, Automobile Liability and Umbrella/Excess
<br />Liability on a Primary, Non-contributory basis where required by written contract. Waiver of Subrogation applies on
<br />General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation where required by written
<br />contract and as permitted by law. Umbrella/Excess policy is follow form over General Liability, Auto Liability and
<br />Employers Liability.
<br />CERTIFICATE HOLDER CANCELLATION
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Everett
<br />Attn: Souheil Nsar
<br />
<br />AUTHORIZED REPRESENTATIVE
<br />3200 Cedar Street
<br />Everett, WA 98201
<br />
<br />ACORD 25 (2016/03)
<br />© 1988-2016 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SR ID: 23337361 BATCH: 2745145
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