|
ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> 9/21/2017
<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(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 UNICO Group, Inc. NAME:CONTACT UNICO Group,Inc.
<br /> 1128 Lincoln Mall PHONE
<br /> Suite 200 E-MAIL(AIC. Ext): 402-434-7200 FAX
<br /> ,No): 402-434-7272
<br /> Lincoln, NE 68508
<br /> E-MAIL
<br /> ESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A: Phoenix Insurance Company 25623
<br /> INSURED INSURER B:
<br /> W -DLR Groupe t,, Suite 600 a WA Corp.
<br /> 51 University Street, INSURER c: Travelers Property Casualty Co.of America
<br /> 51
<br /> Seattle WA 98101-3614 INSURERD: Travelers Indemnity Company
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 37836786 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 ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> A / COMMERCIAL GENERAL LIABILITY 630-9185N623-PHX-16 10/1/2016 10/1/2017 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE ✓ OCCUR DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $ 300,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY / jeCOT- ✓ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY 810-9185N623-PHX-16 10/1/2016 10/1/2017 COMBEDNGLELIMIT $
<br /> (Ea acciINdent)SI1,000,000
<br /> ✓ ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> C / UMBRELLA LIAB ,/ OCCUR CUP-9185N623-TIL-16 10/1/2016 10/1/2017 EACH OCCURRENCE _ $ 3,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000
<br /> DED ✓ RETENTION$10,000 $
<br /> D WORKERS COMPENSATION UB-9185N623-IND-16 10/1/2016 10/1/2017 ,/ Eg_13 OTH-
<br /> ER
<br /> c AND EMPLOYERS'LIABILITY Y/N UB-0161 P573-16 CA Only
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED? NIA
<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,maybe attached if more space Is required)
<br /> The following information is for convenience only:DLR Prj#73-17164-00;Client Contract/File ID:Everett Public Works Rucker Bldg Study
<br /> Certificate Holder&Others are Additional Insureds with respects the operations of the named insured under the Commercial General Liability
<br /> as required by written contract(CGD4140408).
<br /> Employers Stop Gap Liability,if applicable,provided under Workers Compensation coverage.*Workers Compensation
<br /> coverage is not applicable under this policy for State of Washington;Ohio or other monopolistic states.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> 73-17164-00
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City
<br /> City of Everettver Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> (LIN)Robert L.Reynoldson
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br /> 37836786 1 3299 116-17 GL AU UMB MC (STPGP) I (LIN) Marci Elam 19/21/2017 1:25:99 PM (CDT) I Page 1 of 3
<br />
|