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-....,4, CGENGIN-01 DDRAPER
<br /> ACORO DATE(MeDD/YYYY)
<br /> kr.------- CERTIFICATE OF LIABILITY INSURANCE 0711712018
<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 TIE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TFE ISSUING INSURER(S),AUTHORED
<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 tenor 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 /> CONTACT
<br /> PRODUCER IMAM:
<br /> Albany Office ( ; (541)926-4291 FAX
<br /> ,No):(541)926-4298
<br /> PayneWest Insurance,Inc. EMAIL
<br /> 1025 Bain Street SE ADDRESS
<br /> Albany,OR 97322
<br /> INSURERS)AFFORDING COVERAGE- -- NAIC#
<br /> NSURERA:RLI Insurance Company _—_ 13056 -
<br /> INSURED INSURER B:Travelers Casualty&Surety Company 19038
<br /> C G Engineering,PLLC INSURER C:
<br /> 250 4th Ave S,Suite 200 NSR D.
<br /> Edmonds,WA 98020
<br /> INSURER E:
<br /> INSURER F: I
<br /> COVERAGES CERTIFICATE NUNBER: REVISION MJNBER:
<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 /> NSR --_- ADDL SUBRT r POLICY EFF POLICY EXP LBWS
<br /> TYPE OF INSURANCE MD WVD POLICY NUT IER 1 IMWDDIYYTY) INIMDD/Yrril
<br /> A X I COMIMRCIALGENERALLIABLITY EACH_OCCURRENCE $ _ 2,000,000
<br /> CLAIMS-MADE X I OCCUR X PSB0005312 04119/2018 04119/2019 DAMAGE •
<br /> TO RENTED 1,000,000
<br /> PREMISES(Ea occurrence) $__
<br /> MED EXP(Any one person) $ �10,000
<br /> 000
<br /> PERSONAL&ADV INJURY $ 2,00`,
<br /> i
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE j$ 4,000,000
<br /> POLICY X1 78 LOC ', PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: WA STOP GAP $ 1,000,000
<br /> A AUTOMOBLE LIABBJTY (Ee accident)SINGLE LIMIT $ 1,000,000
<br /> X ANY AUTO X PSA0002014 04/19/2018 04/19/2019 BODILY INJURY(r person) $ -
<br /> OWNED I SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> -----
<br /> UE
<br /> OSNLY PROPERTY DAMAGEATOS ONLY
<br /> (Per accident) $
<br /> $
<br /> A LEaRELLALIAB X OCCUR EACH OCCURRENCE _ $ 1,000,000
<br /> X EXCESS UAB CLAIMS-MADE PSE0002337 04119/2018 04/19/2019
<br /> AGGREGATE -$ 1,000,000
<br /> DED RETENTION$ $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABLITY Y/N STATUTE ER-- __--
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE INIA _E.L_EACH ACCIDENT $
<br /> FFFICER/MEMBER EXCLUDED?
<br /> Mandatwy in MI) I_- E.L.DISEASE-EA EMPLOYEE $If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Professional Uab 105423530 04/01/2018 04/01/2019 Per Claim 1,000,000
<br /> B Professional Liab 105423530 04/01/2018 04/01/2019 Aggregate i 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHCLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: Evaluate the structural integrity of the concrete cover of Reservoir#3 and design a replacement platform&ladder for interior of the large vault at the
<br /> Reservoir#3 site.
<br /> City of Everett,its officers,employees and agents are additional insured per attached,PPB304 0212&PPA300WA 0313,which includes primary&
<br /> non-contributory wording.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Cityof Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3200 Cedar St
<br /> Everett,WA 98201 - -
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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