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l ® DATE(MMIDDIYYYY)
<br /> A�o CERTIFICATE OF LIABILITY INSURANCE
<br /> 11/14/2018
<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 CONTACT Annie Santorelli
<br /> NAME:
<br /> Degginger McIntosh and Associates (A/C.
<br /> PHONE
<br /> Fitt; (425)740-5200 FAX
<br /> No): (425)740-5201
<br /> PO Box 1400 E-MAIL Annie@dmainsurance.com
<br /> ADDRESS:
<br /> 3977 Harbour Point Blvd SW INSURER(S)AFFORDING COVERAGE NAIC S
<br /> Mukilteo WA 98275 INSURERA:OhiO Security Insurance Co
<br /> INSURED INSURER B:Ohio Casualty Ins Co
<br /> Bush, Roed & Hitchings, Inc. INSURERC:AXIS Insurance Company
<br /> 2009 Minor Ave E INSURERD:
<br /> INSURER E:
<br /> Seattle WA 98102 INSURERF:
<br /> COVERAGES CERTIFICATE NUMBER:17-18 GL/BA/SG/UM/PL 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 TOALL 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 (MMIDO/YYYY) IMM/DD/YYYY)
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO
<br /> A CLAIMS-MADE X OCCUR PREMISES (EaENTED occurrence) $ 1,000,000
<br /> X Contractual Liability X BRS55823498 12/5/2017 12/5/2018 MED EXP(Any one person) $ 15,000
<br /> PERSONAL 8ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A ALL OWNED SCHEDULED
<br /> AUTOS AUTOS X BAS55823498 12/5/2017 12/5/2018 BODILY INJURY(Per accident) $
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS AUTOS (Per accident
<br /> $
<br /> X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 X 05055823498 12/5/2017 12/5/2018 $
<br /> XXXXIBBMIMNSOBOA PER x OTH-
<br /> XDOXEMPLOYERS'LIABILITYY/N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> A (Mandatory in NH) BRS55823498 12/5/2017 12/5/2018 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000
<br /> C PROFESSIONAL LIABILITY AEA000308-03-2017 12/5/2017 12/5/2018 EACH CLAIM $2,000,000
<br /> AGGREGATE $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> RE: On-Call Surveying Services
<br /> City of Everett is included as Additional Insured per attached form CG8810(0413) with respect to any and
<br /> all operations of the Named Insured. Coverage is Primary and Non-Contributry and includes a Waiver of
<br /> Subrogation per same form, a Per Project Aggregate per attached form CG8870(1208) and Completed
<br /> Operations per attached form CG8583(0413) . Additional Insured on the Auto Liability applies per attached
<br /> form CA8810 (0110). Cancellation applies per attached form IL0146 (0810) . Additional Insured on Umbrella
<br /> Liability applies per attached form CU6002(0697), coverage includes a Waiver of Subrogation per attached
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> abridge@everettwa.gov
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> 3200 Cedar Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett, WA 98201
<br /> AUTHORIZED REPRESENTATIVE 5,, TT
<br /> L David Tyner, III/AN eL�
<br /> I
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025(201401)
<br />
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