HomeMy WebLinkAboutPW13-238 - Insurance Certificate - GeoEngineers, Inc. - County Road 8 Levee - 01/01/2014 Terra Insurance Company TERRA
(A Risk Retention Group) INSURANCE COMPANY
Two Fifer Avenue, Suite 100
Corte Madera, CA 94925
CERTIFICATE OF INSURANCE
DATE
01/01/14
NAME AND ADDRESS OF INSURED
GeoEngineers, Inc.
1101 Fawcett Avenue, Suite 200
Tacoma, WA 98402
This certifies that the"claims made"insurance policy(described below by policy number)written on forms in
use by the Company has been issued. This certificate is not a policy or a binder of insurance and is issued as a
matter of information only,and confers no rights upon the certificate holder. This certificate does not alter,
amend or extend the coverage afforded by this policy.
The policy of insurance listed below has been issued to the insured named above for the policy period
indicated. Notwithstanding any requirement,term or condition of any contract or other document with respect
to which this certificate may be issued or may pertain,the insurance afforded by the policy described herein is
subject to all the terms,exclusions and conditions of such policy. Aggregate limits shown may have been
reduced by paid claims.
TYPE OF INSURANCE Professional Liability
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE
214019 01/01/14 12/31/14
LIMITS OF LIABILITY $2,000,000 EACH CLAIM
$2,000,000 ANNUAL AGGREGATE
PROJECT DESCRIPTION
Hawley Road &County Road 8 Levee Connection Design,Analysis and Certification
GeoEngineers File No. 0410-175-04
CANCELLATION: If the described policy is cancelled by the Company before its expiration date,
the Company will mail written notice to the certificate holder thirty(30)days in advance,or ten
(10)days in advance for non-payment of premium. If the described policy is cancelled by the
insured before its expiration date,the Company will mail written notice to the certificate holder
within thirty (30)days of the notice to the Company from the insured.
CERTIFICATE HOLDER ISSUING COMPANY:
TERRA INSURANCE COMPANY
City of Kent Engineering (A Risk Retention Group)
Attn: Nancy Yoshitake
400 West Gowe
Kent, WA 98032 /\
President
Verify Workers'Camp Premium Status-tritiployer Liability Certificate Page I of I
Washington State Department of 51 TA 11 Employer Liability
Labor and Industries Certificate
%
Department ofLabor'and industries
Employer Liability Certificate
Dat6: fl/13/2013
UBI 4: 600375010
Legal Business Name:
Account 4: Q9,35 1-00
'Doing Business As'Name: GEOENG]NEERS INC
Estimated Workers Reported: Quarter 3 of Year 20.13 "Greater than 100 Workers"'
(See Description Below
Workers' Comp Premium Status: Account is current. Firm,has.-voluntarily reported and
paid their premiums.
Licensed Contractor? Yes
License: GtOENT*l1OJE
Expire.Date: 5/9/201.5
Account Representative: TI /FBARIAED FEROZE(36,0)902-4797�P-Entail:
FERII235@liii,wa.gov
What does "Estimated Workers Reported" mean?
Estimated workers reported represents the number of full time,position requiring at least 480
hours of work per calendar quarter. A single 480 book position may be filled by one person, or
several part time workers.
Industrial Insurance Information
Employers report and pay premiums each quarter based on hours of employee work already
performed, and are liable for premiums found later to be due. Industrial insurance accounts,have
no policy periods, cancellation dates, limitations of coverage or waiver of subrogation(See R—QW
51.12.050 and 51.16.190).
https://fortyess.wa.gov/lni/crpsi/AcctlnfoPrint.aspx?Accountld=42935 100&AccountMana... 11/13/2013