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AC R <br /> L...,- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 09/25/2020 <br /> THIS CERTI FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY <br /> AMEND,EXTEND ORALTERTHE COVERAGE AFFORDED BY THE POUCIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE ISSUING 1NSURER(S), <br /> AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If thecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDMONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED subject to the terms and <br /> 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). <br /> PRODUCER CONTACT <br /> NAME: Laressa Bernhardsen <br /> Mathew Wyatt(792639A) PHONE FAX <br /> 16824 44th Ave W Ste 110 (A/c,NO,EXT):206-826-0199 (A/c,No):425-984-0165 <br /> E-MAIL <br /> Lynnwood WA 98037-3111 ADDRESS: mwyatt@farmersagent.com <br /> INSURERS)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Truck Insurance Exchange 21709 <br /> INSURER B: Farmers Insurance Exchange 21652 <br /> SILVER LAKE CHILDCARE LLC INSURER C: Mid Century Insurance Company 21687 J <br /> PO BOX 14938 <br /> INSURER D: <br /> INSURER E: <br /> MILL CREEK WA 98082 <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POUCI ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POUCY PERIOD INDICATED.NOTWITHSTANDING ANY <br /> REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU ED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE <br /> POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE �Dn SUBR POLICY NUMBER POUCYEFF POUCYEXP LIMITS <br /> LTR INSD WVD (MM/DD(YYYY) (MM/DD/YVYY) <br /> X COMMERCIAL GENERAL UARIUTY EACH OCCURRENCE $ 1000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED $ <br /> PREMISES(Ea Occurrence) 1,000,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A Y N 605842107 06/03/2020 06/03/2021 PERSONAL&ADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE UMITAPPUES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POUCY PROJECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 <br /> OTHER: <br /> $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED AUTOS SCHEDULED BODILY IN <br /> ONLY AUTOS JURY(Per accident)$ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> ONLY AUTOS ONLY (Per accident) $ <br /> I $ <br /> I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS DAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION PER <br /> AND EMPLOYERS'UABIUTY STATUTE OTHER $ <br /> ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ <br /> EXECUTIVE OFFICER/MEMBER N/A <br /> EXCLUDED?(Mandatory in NH) E.L.DISEASE EA EMPLOYEE 8 <br /> If yes,describe under DESCRIPTION OF <br /> OPERATIONS below E.L DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Location: 11525 19TH AVE SE,EVERETT,WA 98208 <br /> Certificate holder below is also named as Additional Insured,see attached endorsement J7238-ED1 02-19 <br /> CERTIRCATE HOLDER CANCELLATION <br /> CITY OF EVERETT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> 2930 WETMORE AVE DATE THEREOF,NOTICE WILL BE DEUVEREDINACCORDANCE WITH THE POLICY PROVISIONS. <br /> STE 8-A AUTHORIZED REPRESENTATIVE <br /> FVFRFTT WA 98201 <br /> ACORD 25(2016/03) J1988-201 5 ACORD CORPORATION.All Rights Reserved <br /> 31-1769 ti-1S The ACORD name and logo are registered marks of ACORD <br />