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DATE (MM/DD/YYYY) <br /> A L' CERTIFICATE OF LIABILITY INSURANCE <br /> 12/08/2017 <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 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 Phone: (425)771-5197 Fax: (425)673-4427 CONTACT Chris <br /> ORION INSURANCE GROUP,INC. PHONE FAX <br /> 3405188TH ST SW INC.No.Ext): (425)771-5197 Z No): (425)673-4427 <br /> SUITE#302 aoo ss: ChrisDay@OrionlnsGroup.com <br /> LYNNWOOD WA 98037 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A : RLI Insurance 13056 <br /> INSURED <br /> HWA GEOSCIENCES INC. INSURER B : Admiral Insurance Company 24856 <br /> 21312 30TH DRIVE SE,SUITE 110 INSURERC : <br /> BOTHELL WA 98021-7010 <br /> INSURER D: <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 20866 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 ADD'L SUER POLICY EFF POLICY EXP <br /> LTR INSR WvO POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> A GENERAL LIABILRY X X PSB0002638 12/01/17 12/01/18 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED 300,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea commence) $ <br /> CLAIMS-MADE X OCCUR MED.EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> POLICY X PRO- II LOC $ <br /> JECT <br /> A AUTOMOBILE LIABILITY X X PSA0001635 12/01/17 12/01/18 COMBINED SINGLE LIMIT 1,000,000 <br /> (Ea accident) $ <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED —SCHEDULED <br /> AUTOS AUTOS <br /> BODILY INJURY(Per accident) $ <br /> _ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE— $ <br /> AUTOS (per accident) <br /> X UMBRELLA LIAB X OCCUR X X PSE0001834 12/01/17 12/01/18 EACH OCCURRENCE $ 5,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PSB0002638 12/01/17 12/01/18 TOC Y LIMITS <br /> OTH <br /> A AND EMPLOYERS' LIABILITY <br /> X TORY LIMITS ER $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> (Mandatory in NH) <br /> Il yes,describe order E.L.DISEASE-POLICY LIMIT $ 2000,000 <br /> DESCRIPTION OF OPERATIONS below r <br /> B Professional Liability Claims Made E000003589302 12/01/17 12/01/18 $2,000,000 Each Occurence <br /> $2,000,000 Aggregate $50,000 Deductible <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) <br /> City of Everett and all required parties are listed as additional insureds with primary non contributory wording. A waiver of subrogation <br /> applies In the favor of additional insureds. Cancellation has been modified to 30 days. <br /> Beverly Lake Sewer Replacement Project <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 3200 Cedar St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Everett,WA 98201 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Attention: <br /> Christopher R. Day <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />