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<br /> • ' .�-•••...1 ALTH001 OP ID:AN1
<br /> AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DOIYYYV)
<br /> D7/17/2020
<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 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 900-544-2672 CONTACT Debra Ryan
<br /> Affinity Insurance Services i PHONEFAX
<br /> 1100 Virginia Drive,Suite 250 (NC,No,Ext): 800-544-2672 FAX
<br /> 847.853.4779
<br /> Fort Washington,PA 19034 __. _ (A/C,No):
<br /> E-MAIL ----
<br /> Affinity Insurance Services ,ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC If
<br /> _- __ _............. _INSURER A:CNA
<br /> INSURED Althea's Footwear Solutions _INSURER B:CNA
<br /> 1932 Broadway {
<br /> Everett,WA 98201 INSURER C:CNA
<br /> INSURER D: I_
<br /> I 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR I TYPE OF INSURANCE ,ADDLSUBRj POLICY ' POLICYEFF POLICY EXP LIMITS i WVD': NUMBERIMM/DD/YYYYIIIMM/DDIYYYYI
<br /> TAR MOD $ 1,000,000
<br /> X ;COMMERCIAL GENERAL LIABILITYI EACH OCCURRENCE
<br /> 16025006492 10/26/2019 10/26/2020 DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR
<br /> PREMISES(Ea occurrence) $ 300,000....._
<br /> x MED EXP jAny one person) _ $ 10,000
<br /> PERSONAL S ADV INJURY }$ 1,000,000
<br /> I GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> PRO- __. _. _.__..
<br /> POLICY JECT I X LOC - 2,000,000
<br /> _ � PRODUCTS-COMP/OP AGG $
<br /> OTHER: $
<br /> AUTOMOBILECOMBINED SINGLE LIMIT
<br /> LIABILITY (Ea accident) _ $
<br /> ANY AUTO ! BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED •
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ii
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> _i AUTOS ONLY _ , AUTOS ONLY (Per accident) $
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE 1,000,000
<br /> EXCESS LIAB CLAIMS-MADE '.6025906508 10/26f2019 10/26/2020 1,000,000
<br /> AGGREGATE
<br /> i DED X I RETENTION$ 10,D00 $
<br /> WORKERS COMPENSATION PER OTH
<br /> :AND EMPLOYERS'LIABILITY ,Ma IPPROP IE NNR EXCLUDED? N I q �� STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N� E.L.EACH ACCIDENT $
<br /> (Mandatory )
<br /> If yes,descnbe under E.L.DISEASE-EA EMPLOYEE $
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> C Professional Liab. 658731040 10/2512019 10/26/2020 Per Claim 2,000,000
<br /> Aggregate 4,000,000
<br /> j
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Covered location:7501 Custer Rd W,Lakewood,WA 98499
<br /> City of Everett,its officers,employees and agents are added to the general liability as additional insured effective 7/812020 as required by contract
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Everett and its officers,employees and agents
<br /> AUTHORIZED REPRESENTATIVE
<br /> Affinity Insurance Services
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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