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AcoRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYYY) <br /> 12/20/2019 <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 POUCIES <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(les)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 rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Scott Kizer <br /> NAME: <br /> SfateFarm Scott Kizer State Farm Insurance IPHHCO NQS}, 253-398-2746 FAX Nob253-398-2748 <br /> Q 3106 SE 240th St Suite 101 scotttscottkizer(nsurance.com <br /> a Kent,WA 98031 INSURERS)AFFORDING COVERAGE NAIC a <br /> INSURER A; State Farm Fire and Casualty Company 25143 <br /> INSURED ItSl1RER B. State Farm Mutual Automobile Insurance Company 25178 <br /> INVISIBLE CREATURE INC INSURER C <br /> 23815 SE 196TH ST INSURER D: <br /> MAPLE VALLEY,WA 98038-8902 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ?AWL SUER POLICY EFF POLICY EXP/YLIMITS <br /> LTR ,INSO WVA POLICY NUMBER 1MM/DDYYYI (MMIDDNYYTI <br /> COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 <br /> DAMAE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES(En occurrence) S 300 <br /> MED EXP(Any one person) S 5,000 <br /> A Y 98-B0-J770-5 03/21/2019 03/21/2020 PERSONAL&ADV INJURY S <br /> GEN.AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 <br /> XPOLICY 7 jER LOC PRODUCTS-COMP/OP AGG S 2,000.000 <br /> OTHER: $ <br /> AUTOMOBILE UABIUTY COMBINED SINGLE UNIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) S <br /> B _.___OWNED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS ONLY _AUTOS <br /> UTAULD PROPERTY <br /> ONLY AUTOS <br /> ( S <br /> UMBRELLA LAB 1 OCCUR EACH OCCURRENCE s _ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE S _ <br /> DED RETENTIONS 5 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'UABIUTY YIN STATUTE ER <br /> /-1 ONYCERRIMEMBER PARTNEEXCLUD/E UTIVE NIA E.L.EACH ACCIDENT S <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S <br /> tt yyes descrbe under <br /> DESoRIPTION OF OPERATIONS bekw j E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Skotdal Real Estate ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 5267 <br /> AUTHORIZED REPRESENTATIVE <br /> Everett,WA 98206 <br /> (01988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> 1001488 132849.12 03.16.2018 <br />