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<br /> ® DATE(MMJDDIYYYY)
<br /> E CERTIFICATE OF LIABILITY INSURANCE 5/26/2015
<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 /> PRODUCERCONTACT .
<br /> NAME:
<br /> Britton Gallagher and Associates, Inc. lac°.."No.E nr:216 658 7100 (NC,No):216-658-7101
<br /> One Cleveland Center,Floor 30 E-MAIL
<br /> 1375 East 9th Street ADDRESS:
<br /> Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA:Everest Indemnity Insurance Co. 10851
<br /> INSURED 18234 INSURER B:Everest National Insurance Company 10120
<br /> Western Display Fireworks Ltd. INSURER C:Axis Surplus Ins Company 26620
<br /> P. O. Box 932 INSURER D:Alaska National Insurance Company
<br /> Canby OR 97013
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES_---_ _ - . -__ OERTIFI -ATENUMBERL.144567-23--1$--- - —REVISION_ILUMBER:— - ------- - - ---
<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 POUCY EFF POUCY EXP
<br /> LTR TYPE OF INSURANCE INSR END POLICY NUMBER (MMIDDM'YY)JMMIDDIYYYYL UMITS
<br /> A GENERALLIABIUTY SI8ML00215-151 1/15/2015 1/15/2016 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $500,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) Si
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE OMIT APPLIES PER: PRODUCTS-COMP/OP AGG S2,000,000
<br /> POLICY X JF O ri LOC $
<br /> B AUTOMOBILE UABIUTY SIBCA00098-151 1/15/2015 1/15/2016 (EaCOMaBBIINdEaD SINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OED PROPERTY DAMAGE $
<br /> X HIRED AUTOS X AUTOSWN (Per accident)
<br /> S
<br /> C UMBRELLA LIAB X OCCUR EAU784636 1/15/2015 1/15/2016 EACH OCCURRENCE $4,000,000
<br /> X EXCESS UAB CLAIMS-MADE AGGREGATE $4,000,000
<br /> DED I RETENTION$ $
<br /> WORKERS COMPENSATION SI8ML00215-151 1/15/2015 1/15/2016 WC STATU- IX OTH- Stop
<br /> A TORY LIMITS ER Gap _
<br /> AND EMPLOYERS'LIABILITY Y/N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EL EACH ACCIDENT S1,000,000 --
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE S1,000,000 __
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000
<br /> D Washington USLH 15DWU08933 4/16/2015 /16/2016 BI by Accident $1,000,000
<br /> BI by disease policy limit$1,000,000
<br /> - BI by disease Each Employee$1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> Date of display:7/4/15
<br /> Display Site: Barge located 850 feet of Jetty Island, Everett,WA 98201
<br /> Additional Insured:
<br /> City of Everett, its officers, employees, and agents
<br /> Everett July Fourth Foundation
<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 /> Everett Fourth of July Foundation ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 2930 Wetmore Ave., Suite 10-A
<br /> Everett WA 97201 AUTHORIZED REPRESENTATIVE
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<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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