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ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1r)
<br /> 1/17/2017
<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(les)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 PeggyMacMillan
<br /> NAME:
<br /> JD Fulwiler & Co. Insurance, Inc. pW(pH�NN (503)293-8325 ucNol,(503)293-5418
<br /> E-MAIL5727 SW Macadam Ave cmillaa@jdfulwiler.comOD ;pma
<br /> PO
<br /> Box 69508 INSURERS)AFFORDING COVERAGE NAIC It
<br /> Portland OR 97239 INsuRERA:Travelers Indemnity Co of CT 25682
<br /> INSURED INSURERB:TraVelers Indemnity Co of Am 25666
<br /> Otak Inc. INSURERC:Saif Corporation 36196
<br /> 808 SW 3rd Ave Ste 300 INsuRERDBeazley Insurance Company Inc
<br /> INSURER E AGCS Marine Insurance
<br /> Portland OR •97204 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:16/18 GEN USE 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 LIMITS
<br /> LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000,
<br /> DAMAGE TO
<br /> A CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ 300,000
<br /> X WA Stop Gap Liability 16805H242469 12/9/2016 1/1/2018 MEDEXP(Anyoneperson) $ 5,000
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000,
<br /> POLICY X jEf X LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: Employee Benefits $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A X ANY AUTO BODILY INJURY(Per person) $
<br /> ALLOWNED SCHEDULED
<br /> AUTOS AUTOS sA1502P892 12/9/2016 1/1/2018 BODILY INJURY(Per accident) $
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> X HIRED AUTOS R AUTOS (Per accident)
<br /> Towing $
<br /> X UMBRELLA UAB XOCCUR EACH OCCURRENCE $ 10,000,000
<br /> B r EXCESS UAB CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> DED X RETENTION$ 10,000 COP5C8570811247 12/9/2016 1/1/2018 $
<br /> WORKERS COMPENSATION OREGON X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A 967262 OTAR Architects Inc E.L.EACH ACCIDENT $ 1,000,000
<br /> C OFFIC(Mandatory
<br /> ERH)EXCLUDED? 487431 OTAR INC 4/1/2016 4/1/2017
<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 /> D A&E Prof'1 W/Pollution V1026160801 12/9/2016 1/1/2018 Limits perClaim/Agg/Ded $2m/$4m/$200K
<br /> E Inland Marine =193070329 12/9/2016 1/1/2018 MlscUnscheduled ltems/Ded $100,000/$lk
<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, employees and agents are included as an additional insureds on the general
<br /> and auto liability with regards to operations of the named insured subject to policy terms, conditions
<br /> and exclusions CGD381 and CAT353; It is further agreed that coverage is primary and non-contributory;
<br /> Cancellation provisions apply per attached form ILT316;
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn: Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett, WA 98201 AUTHORIZED REPRESENTATIVE �� p
<br /> P MacMillan/TMAYDA /--� 5' 1
<br /> -D 4 '&1'"" ,�( _/t
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025 r2mann
<br />
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