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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 pollcy(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. CONTACT <br /> NAME: UNICO Group,Inc. <br /> 1128 Lincoln Mall PHONE <br /> Suite 200 Ext); <br /> E-MAIL <br /> 402-434-7200 FAX No): 402-434-7272 <br /> Lincoln, NE 68508 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Phoenix Insurance Company 25623 <br /> INSURED INSURER B <br /> WA- DLR Group inc., a WA Corp. <br /> 51 University Street, Suite 600 INSURERC: Travelers Property Casualty Co.of America <br /> Seattle WA 98101-3614 INSURER D: 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 LTR TYPE OF INSURANCE NSD DL SUBR WVD POLICY NUMBERM/POLICY EFF POLICY EXP LIMITS <br /> (MM/DD/YYYY) {MDD/YYYY) <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 ✓ jECT / LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY 810-9185N623-PHX-16 10/1/2016 10/1/2017 (Ea accidentSINGLELIMIT $ 1,000,000 <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 �/ STATUTE ERH <br /> AND EMPLOYERS'LIABILITY <br /> C Y/N UB-0161P573-16 CA Only <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBEREXCLUDED? N/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 /> 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 /> City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City ofEverett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 3101 tt CedarA 9Streett ACCORDANCE WITH THE POLICY PROVISIONS. <br /> EveAUTHORIZED REPRESENTATIVE Q L <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 13299 116-17 GL AU UMB WC (STPGP) I (LIN) Marci Elam 19/21/2017 1:25:49 PM (CDT) I Page 1 of 3 <br />