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Client#068454 <br /> MEMORANDUM OF INSURANCE Date Issued 04/23/2019 <br /> Prod ucer This memorandum is issued as a matter of information <br /> only and confers no rights upon the holder. This <br /> Mercer Consumer,a service of memorandum does not amend, extend or alter- - <br /> Mercer Health&Benefits Administration LLC coverages afforded by the Certificate listed below. <br /> P.O.Box 14576 <br /> Des Moines IA 50306-3576 <br /> 1-800-503-9230 <br /> Company Affording Coverage <br /> Insured Liberty Insurance Underwriters Inc. <br /> Lynn D Shatz <br /> Unit D <br /> 1015 132nd Street Southwest <br /> Everett,WA 98204 <br /> This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, not <br /> withstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be <br /> issued or may pertain,the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of <br /> such Certificate.The limits shown may have been reduced by paid claims. <br /> The Memorandum of Insurance and verification of payment are your evidence of coverage. No coverage is afforded unless the premium <br /> is successfully paid in full. <br /> Type of Insurance Certificate Number Effective Date Expiration Date Limits <br /> Professional Liability AHY-630201008 07/01/2019 07/01/2020 Per Incident/ $1,000,000 <br /> DentalHygnt SE Occurrence <br /> Dental Hygienist <br /> Annual Aggregate $3,000,000 <br /> General Liability Per Incident/ <br /> AHY-630201008 07/01/2019 07/01/2020 $1,000,000 <br /> Occurrence <br /> Annual Aggregate $3,000,000 <br /> Coverage includes General Liability occurrences at <br /> 3025 Lombard Everett,WA 98201 <br /> but only as respects to claims arising out of the sole negligence of the Persons Insured under the provisions of this policy. <br /> Memorandum Holder: Should the above describe Certificate be cancelled <br /> PROOF OF COVERAGE ONLY before the expiration date thereof,the issuing company <br /> will endeavor to mail 30 days written notice to the <br /> Memorandum Holder named to the left, but failure to <br /> mail such notice shall impose no obligation or liability <br /> of any kind upon the company, its agents or <br /> representatives. <br /> Authorized Representative <br /> Mark Brostowitz <br /> Mercer Consumer,a service of Mercer Health&Benefits Administration LLC.In CA d/b/a Mercer Health&Benefits Insurance Services LLC.CA License#0G39709 <br />