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ACORL® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/19/2020 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). PRODUCER CONTACT NAME: Stephen Abraham Stephen Abraham(7926306) PHONE FAX 17901 Both!Evrt Hwy#F103 (A/C,NO,EXT):425-776-1100 (A/C,NO):425-481-7794 E-MAIL Mill Creek WA 98012-6387 ADDRESS: sabraham@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 INVANTE HAIR SALON LLC INSURERC: Mid Century Insurance Company 21687 910 SE EVERETT MALL WAY STE INSURER D: 106 INSURER E: EVERETT WA 98208 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 THETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea Occurrence) $ 75,000 • MED EXP(Anyone person) $ 5,000 B Y Y 606766508 10/15/2020 10/15/2021 PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PROJECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 2,000,000 ANY AUTO BODILYINJURY(Perperson) $ B OWNED AUTOS SCHEDULED BODILYINJURY(Peraccident)$ ONLY AUTOS N 606766508 10/15/2020 10/15/2021 HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY (Per accident) UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ 'ON N/A E.L.EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER E.L.DISEASE-EA EMPLOYEE $ EXCLUDED?(Mandatory in NH) If yes,describe under DESCRIPTION OF E.L.DISEASE-POLICY LIMIT $ OPERATIONS below EMPLOYERS LIABILITY/STOP EACH ACCIDENT 1,000,000 B GAP 606766508 10/15/2020 10/15/2021 EACH EMPLOYEE 1,000,000 POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 910 SE EVERETT MALL WAY STE, EVERETT,WA 98208 City of Everett is listed as Additional Insured per attached form. CERTIFICATE HOLDER CANCELLATION CITY OF EVERETT, ITS OFFICERS, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EMPLOYEES AND AGENTS DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. 2930 WETMORE AVE#10A AUTHORIZED REPRESENTATIVE 5, ,e �j` /LG.I�IL EVERETT WA 98201 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD