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DATE(M <br /> AcoRD M/DD/YYYY) <br /> ® CERTIFICATE OF LIABILITY INSURANCE 0 DATE(M 020 <br /> Lam. <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 POUCIES <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 /> NBS Insurance Agency, Inc. (A/CNEMAL,Ext):(800) 444-1744 �,No): (877) 444-4094 <br /> PO Box 182500 ADDRESS <br /> Columbus, OH 43218 INSURE(S)AFFORDING COVERAGE NAIL# <br /> INSURERA: Guard 42390 <br /> INSURED INSURER B: <br /> Washington Gas Mart Limited INSURER C: <br /> 6132 Evergreen WayINSURERD: <br /> Everett, WA <br /> 98203 <br /> 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. NOTVVITHSTAND(NG 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MMIDLYYYYY) IMMIDD/YYYY) UNITS <br /> A x COMMERCIAL GENERAL LIABIUTY WABP130750 07/02/2020 07/02/2021DAMAGE TO RENTED <br /> EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ <br /> MEDEXP(Anyoneperson) $5,000 <br /> PERSONAL BADVINJURY $INCLUDED <br /> GEM&AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE $2,000,000 <br /> X POLICY JJEECTT LOC PRODUCTS-COMROP AGO $2,000,000 <br /> OTHER: $ <br /> AUTOMOBILELIABIUTY 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 /> N-O PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Per accident) <br /> $ <br /> UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS LIABILITY Y/N STATUTE ERH <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EL.EACH ACCIDENT $ <br /> OFFiCER/MEMBER EXCLUDED? <br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ <br /> If yes describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY UMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Listed as a Loss Payee - CP 12 06 <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Everett, Its Officers, Employees, and Agents <br /> 2 930 Wetmore Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Everett, WA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POUCY PROVISIONS. <br /> 98201 <br /> AUTHORIZED REPRE IVE <br /> 01988-2014 AC•'4AtATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> DS#34688826 <br />