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<br /> ,CCPR©' CERTIFICATE OF LIABILITY INSURANCE - 10/29/2014 - -
<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 /> CONTACT
<br /> PRODUCER NAME:
<br /> The Unity Group (A//CC..N.EX0:360-647-9000 FAiXc,No):360-734 8496
<br /> 110 Unity Street E-MAIL
<br /> Bellingham WA 98225 ADDREss:Info@theunitygroup.com
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<br /> INSURER A:American Fire&Casualty Co 24066
<br /> INSURED MATER-1 INSURER B:Ohio Casualty Insurance
<br /> Materials Testing and Consulting Inc. INSURER c:Endurance American Specialty
<br /> 777 Chrysler Dr INSURER D:
<br /> Burlington WA 98233-4100
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1802893183 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 /> ILTR TYPE OF INSURANCE I SR POLICYSLIER W POLICY NUMBER I
<br /> VD (MM/DDIYYYY) (MM DDIYYYY)I LIMITS
<br /> A GENERAL LIABILITY Y Y BKA54530460 7/1/2014 7/1/2015 EACH OCCURRENCE I$1,000,000
<br /> DAMAGE TO RENTED
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $100,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $15,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
<br /> POLICY I"' PE LOC I $
<br /> A AUTOMOBILE LIABILITY Y Y BM54530460 7/112014 /1/2015 (Ea a denBINED SINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY{Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS
<br /> PROPERTY DAMAGE
<br /> HRTEDAUTOS —AUTOS NON-OWNED
<br /> (Per accident) $
<br /> I$
<br /> B X UMBRELLA LIAB X OCCUR Y Y US05453046D 7/1/2014 7/1/2015 EACH OCCURRENCE I$2,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000
<br /> DED IX RETENTION$0 $
<br /> A WORKERS COMPENSATION BKA54530460 7/1/2014 7/1/2015 WC STATU- IX I OTH- WA St Gap
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA - EL EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED?(Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $1,000,000
<br /> C Professional Liability N N DPL10002153804 7/1/2014 7/1/2015 Occurence $2,000,000
<br /> Deduct$10,000 Aggregate $2,000,000
<br /> Claims Made
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> Per forms and conditions.CG 85 83 04 13—Blanket Additional Insured Products and Completed Operations;CG 88 10 04 13—Additional
<br /> Insured,Primary/Non-Contributory&Waiver of Subrogation;CG 88 6012 08 Per Location Aggregate; CG 88 70 12 08 Per Project
<br /> Aggregate;CL0103 0310 General Liability Cancellation Provision.CA 00 01 0310 Auto Coverage Form;CA 88 10 01 10 Auto Additional
<br /> Insured Waiver of Subrogation; 1L0146 0810.Auto Cancellation Provision.14-02-4231 07 2001 Professional Liability Cancellation
<br /> Provisions. Retro Date per Occurrence Limit:01-21-2000/Aggregate Limit 11-22-2011/$2,000,000 limits 07-01-2014. Umbrella is Following
<br /> Form.
<br /> See Attached...
<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 /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3101 Cedar Street
<br /> Everett WA 98201 AUTHORIZED REPRESENTATIVE
<br /> 71/77,4
<br /> I ✓ .
<br /> ©1988-2010 ACORD CORPORATION.-All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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