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C DATE(MM/DD/YYYY) <br /> A <br /> CO CERTIFICATE OF LIABILITY INSURANCE 10/15/2020 <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 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 /> Klein Insurance Agency Inc (Ea/c No,Ertl: INC,No): <br /> 3131 Smokey Point Dr Suite 7 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC M <br /> Arlington WA 98223 INSURERA: Scottsdale Insurance Co. 41297 <br /> INSURED <br /> INSURER B <br /> Writhe Pole Dance,LLC INSURER C: <br /> 9823 64th Dr NE INSURER D: <br /> INSURER E: <br /> Marysville WA 98270 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 ADDLSUBR - POLICYEFF POUCYEXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) UMITS <br /> X COMMERCIAL GENERAL UABILITY EACH OCCURRENCEDAMAGE T $ 1,000,000 <br /> RENTED <br /> CLAIMS-MADE l X I OCCUR PREM SESO(Ea occurrence) S 100,000 <br /> MED EXP(Any one person) S 5,000 <br /> A Y CPS3323287 02/06/2020 02/06/2021 PERSONAL SADVINJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PRO LOC <br /> JECT PRODUCTS-COMP/OPAGG $ Included <br /> OTHER <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S <br /> (Ea accident) <br /> _ ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED ^SCHEDULED BODILY INJURY(Per accident) S <br /> _ AUTOS , AUTOS _. <br /> NON-OWNED PROPERTY DAMAGE S <br /> HIRED AUTOS _AUTOS (Per accident) <br /> S <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> DED RETENTION S <br /> WORKERS COMPENSATION PER <br /> AND EMPLOYERS'LIABILITY YIN STATUTE EERH <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E L EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDED' N <br /> (Mandatory in NH) E L DISEASE-EA EMPLOYEE S <br /> If yes describe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> Certificate Holder is named as Additional Insured per from CG2012(12/19). <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 /> City of Everett,ISAOA ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2930 Wetmore Ace,Ste 10A AUTHORIZED REPRESENTATIVE <br /> Everett WA 98201 <br /> l ?Tv <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />