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DATE(MM/DD/YYYY) <br /> '`' n CERTIFICATE OF LIABILITY INSURANCE 11/15/2019 <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 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 Johnny Jae-Kyun Lim <br /> Johnny Jae-Kyun Lim PHONEExt). (425)678-8202 Ax No). (425)678-8213 <br /> A/C No (FA/C <br /> 7500 196TH St SW Ste H E-MAIL 1lim m <br /> amfam.co <br /> Lynnwood, WA 98036 AnnRFss @ <br /> (425)678-8202 (026/353) INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:American Family Mutual Insurance Company 19275 <br /> INSURED INSURER B: <br /> Tuanh Nhat Nguyen INSURER C: <br /> 6121 176TH ST SW#E INSURER D: <br /> LYNNWOOD,WA 98037 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 /> INSR ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ <br /> ❑ANY AUTO BODILY INJURY(Per accident) $ <br /> ❑ ALL OWNED ❑ SCHEDULED PROPERTY DAMAGE <br /> AUTOS AUTOS (Perarrident) <br /> ❑ HIRED AUTOS ❑AUTONON-OWNED BODILY INJURY $ <br /> S <br /> ❑ ❑ <br /> GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> ❑x COMMERCIAL GENERAL LIABILITY PREMISES RENTED occurrence) $ 50,000 <br /> ❑ ❑ CLAIMS-MADE ❑ OCCUR MED EXP(Any one person) $ 5,000 <br /> ❑ BPP 1014093 09/06/2019 09/06/2020 PERSONAL&ADV INJURY $ <br /> ❑ GENERAL AGGREGATE $ 4,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000 <br /> ❑X POLICY ❑ PROJECT ❑ LOC $ <br /> ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ <br /> ❑ EXCESS LIAB ❑ CLAIMS-MADE AGGREGATE $ <br /> ❑ DED ❑RETENTION$ $ <br /> WORKERS COMPENSATION <br /> OT RY LIM TS ❑OTHER <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Business Personal Property (Replacement Cost) $5,000 <br /> City of Everett, WA and its officers, employees and agents. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 2930 Wetmore Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Everett WA 98201 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Diane Del Valle <br /> (&)1988-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />