Laserfiche WebLink
Client#: 326119 GEOENINC2 <br /> ACORD.. CERTIFICATE OF LIABILITY INSURANCE 5/0DATE(MM/DD/YYYY) <br /> MMDD/Y <br /> 8/2019 <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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAMEACT Tracy Taylor <br /> USI Insurance Services NW PR PHONE 206 441-6300 FAX 610-362-8530 <br /> (A/C,No,Ext): (A/C,No): <br /> 601 Union Street,Suite 1000 ADDREE-MAIL SS: Seattle.PLCertRequest@usi.com <br /> uest/�usi.com <br /> Seattle,WA 98101 <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Continental Insurance Company 35289 <br /> INSURED INSURER B:National Fire Insurance Co.of Hartford 20478 <br /> GeoEngineers, Inc. y m valla Forge an 20508 <br /> INSURER C: p y <br /> 17425 NE Union Hill Road,Suite 250 <br /> INSURER D: <br /> Redmond,WA 98052 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 /> LTRINSR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM/DDY/YEYYY) (MM/DDY/YYYY) <br /> LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY X X 6023113030 03/31/2018 06/30/2019 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR <br /> DAMAGETORENTED $500,000 <br /> X Stop Gap WA OH ND MED EXP(Any one person) $15 000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY <br /> PRO- LOC PRODUCTS-COMP/OPAGG $2,000,000 <br /> X JECT <br /> OTHER: Stop Gap/EL $1,000,000 <br /> B AUTOMOBILE LIABILITY X X 6023117823 03/31/2018 06/30/2019Ea COMBI <br /> acciNEDdent)SINGLE LIMIT $1,000,000 <br /> ( <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> X AUTOS ONLY X AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> B WORKERS COMPENSATION X 6045838328 03/31/2018 06/30/2019 X STATUTE 0TH <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N (CA Incl: USL&H) (Incd:MEL) E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N N/A <br /> C (Mandatory in NH) X 6045839429 03/31/2018 06/30/2019 E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If under <br /> DEes,SCRIPTION OF O (AOS Incl: USL&H) (Incd:MEL) E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE: GeoEngineers Project No.0661-119-00; Project Name and Location: 6700 and 8400 Larimer Road Embankment <br /> Evaluation,Everett,Washington. <br /> The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement <br /> that provides Additional Insured status to The City of Everett,and its officers,employees and agents, <br /> (See Attached Descriptions) <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 /> 3200 Cedar Street ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett,WA 98201 <br /> AUTHORIZED REPRESENTATIVE <br /> 1;61".--- <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD <br /> #S25642693/M25301742 SRSJV <br />