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GEOEINC-01 YADAVYO
<br /> AC-ORO DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 7/26/2016
<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 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 Willis Towers Watson Certificate Center
<br /> NAME:
<br /> Willis of Seattle,Inc. PHONE 877 945-7378 FAX 467-2378
<br /> c/o 26 Century Blvd (A/C.No,Ext): ) (A/c,No):(888)
<br /> P.O.Box 30591 E-MAIL
<br /> DRESS:Certificates@WillisTowersWatson.com
<br /> Nashville,TN 37230-5191
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Continental Insurance Company 35289
<br /> INSURED INSURER B:National Fire Insurance Company of Hartford 20478
<br /> GeoEngineers,Inc. INSURERC:Valley Forge Insurance Company 20508
<br /> 8410 154th Ave. NE INSURER D:
<br /> Redmond,WA 98052 INSURERE:
<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 ADDL SUBR POLICY EFF POLICY EXP WLIMITS
<br /> LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X 6024049165 03/31/2016 03/31/2017 DAMAGE 10REN1ED 100,000
<br /> PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 15,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: WA STOP GAP $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> B X ANY AUTO X 6024049196 03/31/2016 03/31/2017 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-0WN-O NED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident)
<br /> $
<br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE _$
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION X
<br /> AND EMPLOYERS'LIABILITY STATUTE OTH-
<br /> ER
<br /> Y/N
<br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE 6024049179 03/31/2016 03/31/2017 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N I A
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
<br /> THIS CERTIFICATE VOIDS&REPLACES THE PREVIOUSLY ISSUED CERTIFICATE DATED 3/31/2016
<br /> Re:City of Everett--2016 Professional Service Agreement,GEI Project#0661-108-00 Smith Street Sawmill Phase I ESA,3600 Smith Avenue,Everett,WA.
<br /> USL&H and Maritime Employers Liability coverage is included under Workers'Compensation coverage evidenced above.
<br /> City of Everett,its officers,employees and agents are included as an Additional Insured as respects to General Liability and Auto Liability as required by
<br /> written contract.
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> City ofEverett c..7 77'is7`, �1t1�Y✓
<br /> 3200 Cedar Street � �'`7
<br /> (Everett,WA 98201
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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