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A ® DATE(MM/DD/YY
<br /> YY)
<br /> CERTIFICATE OF LIABILITY INSURANCE
<br /> L------- 01/09/2019
<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 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 CONTACT Kim Grahn
<br /> NAME:
<br /> Shipley&Pease Insurance PHO No Ext): (206)519-5371 FAX,(A/ No): (503)282-3345
<br /> (A/C,P 0 Box 928 E-MAIL kim@shipleyins.com
<br /> ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC k
<br /> Woodinville WA 98072INSURERA: Travelers Indemnity of America(TIA) 25666
<br /> INSUREDINSURER B: Travelers Insurance Company
<br /> Botesch Nash&Hall Architects PS INSURER C:
<br /> 2727 Oaks Ave Ste 100 INSURER D:
<br /> INSURER E:
<br /> Everett WA 98201 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: CL1883101023 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 VVITH 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 ADDTYPE OF INSURANCE IVSD WVDUBR POLICY NUMBER MMDDPOLICYIYYYY MM DDIYYYY LIMITS
<br /> EFF POLICY EXP
<br /> LTR INSD WVD ( ) ( )
<br /> X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED , 1,000,000
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence)
<br /> MED EXP(Any one person) $ 5,000
<br /> A Y Y 6806H037238 09/01/2018 09/01/2019 PERSONAL BADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X PROT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> JEC
<br /> OTHER: $
<br /> AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y BA6H10369A 09/01/2018 09/01/2019 BODILY INJURY(Per accident) $
<br /> AUTOS ONLY _ AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br /> A EXCESS LIAB CLAIMS-MADE Y Y CUP6H038407 09/01/2018 09/01/2019 AGGREGATE $ 2,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION PER 0TH- WA Stop Gap
<br /> AND EMPLOYERS'LIABIUTY STATUTE ER
<br /> YIN 1,000,000
<br /> A FY PROPRIETOR/PARTNER/EXECUTIVE R/PARTNE EDXECUTIVE N/A 6806H037238 09/01/2018 09/01/2019 E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> It yes,describe under 10 ,
<br /> 00000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ,
<br /> Each Claim $2,000,000
<br /> Professional Liability
<br /> B 106584589 09/01/2018 09/01/2020 Aggregate $4,000,000
<br /> Deductible $10,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett,its officers,employees and agents are Additional insured per CGD381 09/07.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3101 Cedar Street
<br /> AUTHORIZED REPRESENTATIVE
<br /> Everett WA 98201 -
<br /> ii
<br /> I
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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