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Client#: 326119 GEOENINC2
<br /> YYYY)
<br /> /2017 MIDDI
<br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE 9/28DATE(MM/DDI
<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 ACT
<br /> Please send all requests by
<br /> USI Kibble&Prentice PHONE fax or email FAX 610-362-8528
<br /> (AIC,No,Ext): (A/C,No):
<br /> 601 Union Street,Suite 1000 nDDRless: PL.CertRequest@usi.com
<br /> Seattle,WA 98101
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> 206-441-6300
<br /> INSURER A Continental Insurance Company 35289
<br /> INSURED INSURER B:Liberty Insurance Corporation 42404
<br /> GeoEngineers, Inc. 20508
<br /> INSURER C:Valley Forge Insurance Company
<br /> 8410 154th Ave NE
<br /> INSURER D Natl Fire Ins Co of Hartford 20478
<br /> Redmond,WA 98052
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: K1 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 /> LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY X X 6023113030 03/31/2017 03/31/2018 EACH OCCURRENCE $1,000,000
<br /> CLAIMS-MADE X OCCUR PREMISESO(Ea occu ence) $500,000
<br /> X WA&ND Stop Gap MED EXP(Any one person) $15
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> PRO-POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: Stop Gap/EL $1,000,000
<br /> D AUTOMOBILE LIABILITY X X 6023117823 03/31/2017 03/31/2010 COMBINEDaccident)SI $NGLELIMIT 1,000 000
<br /> (Ea
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X HIRED AUTOS X AUUTOS ED (Peer acc EdentDAMAGE
<br /> B X UMBRELLA LIAB x OCCUR X X TH7661066735017 03/31/2017 03/31/2018 EACH OCCURRENCE $1,000,000
<br /> EXCESS LIAB CLAIMS-MADE XS of GL,Auto& AGGREGATE $1,000,000
<br /> DED X RETENTION$10,000 - Employers Liab. $
<br /> C WORKERS COMPENSATION X WC6045639429 03/31/2017 03/31/2018 X STATUTE ETH
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N ID LA MO NC NY OR UT USL&H/MELT.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> D (Mandatory in NH) X WC6045838328 03/31/2017 03/31/2018 E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below CA incl USL&H/MEL "incl WA E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> 0661-113-00-7400 Block Lowell-Larimer Road Stabilization, Everett,Washington.
<br /> The City of Everett,and its officers,employees and agentsare Additional Insured,coverage is
<br /> primary and noncontributory and waiver of subrogation applies as respects General Liability and Automobile
<br /> Liability if required by written contract per attached endorsements.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn: Grant Moen ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar Street
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE
<br /> •
<br /> ©1988-2014 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br /> #S21591829/M20200859 MXTJU
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