Otak, Inc 8/15/2016 - Laserfiche WebLink

Q® ACDATE(MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE 7/22/2016 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(ies) must 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 PeggyMacMillan NAME: JD Fulwiler & Co. Insurance, Inc. (AICNr o Ext: (503)293-8325 FAX (NC,No):(503)293-5418 5727 SW Macadam Ave ADDE-MRE AILSS:p 'macmillan@dfulwiler.com � PO Box 69508 INSURER(S)AFFORDINGCOVERAGE NAIC# Portland OR 97239 IN5uRERA:Travelers Indemnity Co of CT 25682 INSURED INSURERB:Travelers Indemnity Co of Am 25666 Otak Inc. INSURERC:Saif Corporation 36196 808 SW 3rd Ave Ste 300 INSURERDBeazley Insurance Company Inc INSURER E Allianza Global Risk US Insurance Portland OR 97204 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 Gen USE 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 AS EFF LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDY/YYYY) (MM//DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000_ A CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES PREMISES(Ea occurrence) $ X WA Stop Gap Liability 6801497P251 12/9/2015 12/9/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X Fief X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BA1502P892 12/9/2015 12/9/2016 BODILY INJURY(Per accident). $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE — X AUTOS (Per accident) $ X HIRED AUTOS Towing $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 CUP5C8570811247 12/9/2015 12/9/2016 $ WORKERS COMPENSATION **OREGON** X SPER TATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 487431 OTAK INC 4/1/2016 4/1/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A C (Mandatory in NH) 967262 OTAK Architects Inc 4/1/2016 4/1/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D A&E Prof']. w/Pollution V10267150701 12/9/2015 12/9/2016 Limit perclaim/Agg/Ded $2m/$4m/$200K E Inland Marine MXI93070328 12/9/2015 12/9/2016 MiscUnscheduledltems/Ded $100,00/$5k DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: DD5 Dike Repair Otak Project #32758; naming the City of Everett, its officers, employees and agents are included as additional insureds on the general liability and auto liability with regard to operations of the named insured subject to policy terms, conditions and exclusions per attached forms CGD381 & CAT4370808; It is further agreed that coverage is primary and non-contributory; Cancellation provisions apply per attached form IL316; CERTIFICATE HOLDER CANCELLATION HKimball@everettwa.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 3200 Cedar St Everett, WA 98201 AUTHORIZED REPRESENTATIVE �,/ P MacMillan/TMAYDA , 9 - -A/z2 -2-056ZlL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 1701401/