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ACOREP <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 12/10/2019 <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 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 /> PRODUCER CONTACT <br /> NAME: <br /> (A/c.NENo.Ext):(888)210-9641 FAX <br /> No): (888)210-9642 <br /> Zem Insurance Solutions E-MAIL <br /> ADDRESS: <br /> 500 La Terraza Blvd.Suite#150 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Escondido CA 92025 INSURER A:Colony Insurance Company <br /> INSURED INSURER B: <br /> Trillium Ink LTD. <br /> INSURER C: <br /> dba:Trillium Ink;Trillium Ink Academy INSURER D: <br /> 3418 Broadway INSURER E: <br /> Everett WA 98201 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDLTYPE OF INSURANCE INSR WVD <br /> SUBR POLICY EFF POLICY EXP <br /> LTR INSR VD POLICY NUMBER (MM DDIYYYY) (MM DDIYYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED 100,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ _ <br /> —1 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 <br /> A X $500,000 Professional Liability TAT801A31665 12/06/2019 12/06/2020 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 /> X POLICY PRO- <br /> JECT LOC Communicable Disease $100,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ■ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Per accident) _ <br /> IUMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH-I <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER — <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> PROOF OF INSURANCE <br /> i <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 /> Trillium Ink LTD. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> dba:Trillium Ink;Trillium Ink Academy <br /> AUTHORIZED REPRESENTATIVE ..q� <br /> 3418 Broadway <br /> cletA;v‘. 1,,,‘,......_, <br /> Everett WA 98201 <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />