|
Client#: 323148 OACSER
<br /> ACORDT,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMADD/YVYY)5/26/2016
<br /> CHIS 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 be endorsed.If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Kibble& Prentice, a USI Co PR PHONE 206 441-6300 FAX
<br /> (A/c,No,Ext): (A/C,No): 610-362-8528
<br /> 601 Union Street, Suite 1000 ataEss: PL.CertRequest@usi.biz
<br /> Seattle,WA 98101
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<br /> INSURER A:Travelers Indemnity Co.of Amer 25666
<br /> INSURED INSURER B:Travelers Casualty and Surety C 31194
<br /> OAC Services Inc. INSURER C:Phoenix Insurance Company 25623
<br /> 701 Dexter Avenue North,Suite 301
<br /> Seattle,WA 98109 INSURER D
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY 6801809L854 05/20/2016 05/20/2017 EACH
<br /> �ES(OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR PREMISEa occurrence) $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY X JECT I_ LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: $
<br /> C AUTOMOBILE LIABILITY BA1810L355 05/20/2016 05/20/2017 COMacciBINdent) r
<br /> ED SINGLE LIMIT 1
<br /> _ ,000,000
<br /> (Ea
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS (Per accident)
<br /> UMBRELLA LIAR OCCUR _EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION$ $
<br /> A WORKERS COMPENSATION 6801809L854 05/20/2016 05/20/2017PER IP-
<br /> AND EMPLOYERS'LIABILITY STATUTE X ER
<br /> Y
<br /> ANY OFFICEW PROPRIETOR/
<br /> EXRTNER E ECUTIVE N N/A (WA Stop Gap) E.L.EACH ACCIDENT $1,000,000
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> It yes,describe under
<br /> DESCRIPTION OF OPERATIONS below -_ E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Professional 105937003 05/20/2016 05/20/2017 $3,000,000 per claim
<br /> Liability $3,000,000 annl aggr.
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> RE:OAC Job#R2016105.01.
<br /> The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement
<br /> that provides Additional Insured status to the Certificate Holder,its officers,employees and agents,only
<br /> when there is a written contract that requires such status,and only with regard to work performed on
<br /> behalf of the named insured.The General Liability and Automobile Liability policies contain a special
<br /> endorsement with Primary wording,when required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn: George Baxter ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3225 Cedar Street
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE REPRESENTATIVEENTATIVE
<br /> elatitSdai
<br /> ©1988-2014 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2014;01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S17923959/M17857417 LZGZP
<br />
|