Fernec Doner dba Argonaut Diving 12/3/2019

PL105 THIS POLICY DOES NOT AUTOMATICALLY RENEW PROFESSIONAL LIABILITY INSURANCE UNDERWRITER: DAN RISK RETENTION'GROUP,INC. DA�� offered through _R_ DAN SERVICES,INC. RISK ETENTION CI GRUF NAIC NO. 15928 - SC COMPANY CODE:207640 6 W.Colony Place,Suite 200, Durham,NC 27705 DECLARATIONS PAGE Named Insured Argonaut Diving Policy Number: GPL105-11841 DBA Argonaut Diving Policyholder ID: 2839694 Address 919 Olympic Ave See Policy for a full description of terms, City,State,Zip Edmonds,WA 98020 conditions,limitations&exclusions. SCHEDULE OF INSURED TEACHING STAFF NAME ADDRESS CITY STATE ZIP Ferenc Doner 919 Olympic Ave Edmonds WA 98020 Zhiji Huang 12702 219th PI SE Sonomish WA 98296 Erika Obaitek 10313 210th St SE Sonomish WA 98296 Sage Haynes 5123 N Pearl St Tacoma WA 98407 Brian O'Connor 23778 Brixton Place NW Poulsbo WA 98370 Lonny Bartholomew 12015 Marine Dr#158 Tulalip WA 98271 Josephine Woods 3006 86th St NW Tulalip WA 98271 Travis Sterner 15522 SE 4th St Bellevue WA 98007 Kaitlin Swartz 22915 75th Ave W Edmonds WA 98026 Christopher Murphy 3204 96th PL SE Everette WA 98208 Nicholas Angelette 19733 24th Dr SE Bothell WA 98012 SCHEDULE OF ADDITIONAL NAMED INSURED NAME ADDRESS CITY STATE ZIP Forest Park Pool/City of Everett 802 E Mukilteo Blvd Everette WA 98203 Exotic Aquatics 328 Madison Ave N Suite B Bainbridge Island WA 98110 Edmonds Underwater Sports 264 Railroad Ave Edmonds WA 98020 Yost Pool/City of Edmonds 9535 Bowdoin Way Edmonds WA 98020 Shoreline Pool 190301st Ave NE Shoreline WA 98155 Underwater Sports Inc. 10545 Aurora Ave N Seattle WA 98133 Bandito Charters 1616 E D Street#1-4 Tacoma WA 98421 SDI/TDI 1321 SE Decker Ave. Stuart FL 34994 PADI 30151 Tomas Rancho Santa Margarita CA 93688 Silent World Diving Systems Inc 1910 132nd Ave NE Suite 11 Bellevue WA 98005 Octopus Garden Diving 2410 Washington St Port Townsend WA 98368 SCHEDULE OF DESIGNATED REBREATHER MANUFACTURER NAME MODEL CERTIFICATION AGENCY No.