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ACUR U`� DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 11/02/2020 <br /> 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 <br /> 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), <br /> AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> 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 <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: <br /> Chong Ho(792637C) PHONE FAX <br /> 12006 98th Ave NE Ste 102 (A/C,NO,EXT):206-227-0670 (A/C,NO):425-285-2375 <br /> E-MAIL <br /> Kirkland WA 98034-4218 ADDRESS: cho2@farmersagent.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Truck Insurance Exchange 21709 <br /> INSURERS: Farmers Insurance Exchange 21652 <br /> SI JOY INC <br /> DBA:OSHIMA SUSHI INSURER C: Mid Century Insurance Company 21687 <br /> INSURER D: <br /> 11108 EVERGREEN WAY STE B <br /> EVERETT WA 98204 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 NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY <br /> 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 <br /> POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDTL SUER pOUCY NUMBER POUCY EFF POLICY EXP UMITS <br /> LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES(Ea Occurrence) $ 75,000 <br /> MEDEXP(Anyoneperson) $ 5,000 <br /> B Y N 605484849 09/10/2020 09/10/2021 PERSONAL&ADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY I , PROJECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILYINJURY(Perperson) $ <br /> OWNED AUTOS SCHEDULED BODILY INJURY(Per accident)$ <br /> ONLY AUTOS N <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> ONLY AUTOS ONLY (Per accident) <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTHER $ <br /> AND EMPLOYERS'LIABILITY STATUTE <br /> ANY PROPRIETOR/PARTNER/ YIN E.L.EACH ACCIDENT $ <br /> EXECUTIVE OFFICER/MEMBER N/A <br /> E.L.DISEASE-EA EMPLOYEE $ <br /> EXCLUDED?(Mandatory in NH) <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 /> additional Insured-City of Everett-930 WETMORE AVE STE 100 EVERETT,WA 98201 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITY OF EVERETT SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFO THE EXPI TI <br /> 2930 WETMORE AVE DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE W PO P VI NS. <br /> STE 100 AUTHORIZED REPRESENT <br /> EVFRETT WA Q8201 <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved <br /> 31-1769 11-15 The ACORD name and logo are registered marks of ACORD <br />