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AC O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/15/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT DAVID NAME: StateFarm DAVID STRASSER AGENCY PHONE 425-347-4685 ; FAX (A/C.No.Est!" ((A/C,No): 1094l►` 1700 132ND ST SE SUITE H ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# MILL CREEK WA 98012 INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER B: MANJIT&AJMER ENTERPRISES LLC INSURER C: 1 DBA SKINNY D'S YOGURT INSURER D: 6930 132ND ST SE INSURER E: SNOHOMISH WA 98296 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBRI I POLICY EFF POLICY EXP j LTR I TYPE OF INSURANCE INSR WVD I POLICY NUMBER I(MMIDD/YYYY) (MM/DD/YYYYI 1 LIMITS 'X;COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR DAMAGE PREMISES O(EaEoccu RENTED S 300,000 MED EXP(Any one person) S 5,000 A Y 98-B4-H544-1 11/26/2019 11/26/2020 PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG S 1,000,000 OTHER: S AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ' BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS I BODILY INJURY(Per accident) S HIRED NON-0WNED PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE I AGGREGATE I$ DED I RETENTIONS i S WORKERS COMPENSATION PER OTH I STA - AND EMPLOYERS'LIABILITY TUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A'; (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF EVERETT ITS OFFICERS,EMPLOYEES AND AGENTS AUTHORIZED REPRE NTATIVE ii/LL.r. EVERETT WA 98201 i © 015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered m s of ACORD 1001486 132849.13 04-22-2020