The Dance School 11/9/2020 - Laserfiche WebLink

Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `r 10/30/2020 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). CONTACT PRODUCER Liberty Mutual Insurance NAME: PO Box 188065 PHONE FAX Fairfield, OH 45018 _(NC.No.EXtl: 800-962 7132 (NC,No): 800 845 3666 ADDRESS: BusinessService oALibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: West American Insurance Company 44393 INSURED INSURER B: American Fire and Casualty Company 24066 The Dance School PO Box 1833 INSURER C: Everett WA 98206 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 58388314 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY)_ A / COMMERCIAL GENERAL LIABILITY iBKW57336740 9/19/2020 9/19/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE / OCCUR PREMISES(EaENTED occurrrence) $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY jEa LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAA57336740 9/19/2020 9/19/2021 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION BKW57336740 9/19/2020 9/19/2021 PER H PEATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) Stop Gap E.L.DISEASE-EA EMPLOYEE $1,000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Everett,its officers,employees and agents is listed as Additional Insured Designated Person or Organization per form CG2026. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Office of Economic Development THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore Ave, Suite 10A Everett WA 98201 AUTHORIZED REPRESENTATIVE dalovit Brock Johnson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 58388314 1 57336740 1 20-21 GL AU 1 Brock Johnson 1 10/30/2020 3:03:42 PM (PDT) 1 Page 1 of 2