Clio Samia-Lindenauer DDS PLLC 11/30/2020

ACORL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10l19/2020 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 Angela Anderson NAME: g Pacific Underwriters Corp. {A"rc°NIv,Ext) (206)248 2254 !FAX No_)(206)248-0130 12611 Des Moines Mem. Dr. E-MAIL ADDRESS:Rkunz@PacificUnderwriters.com PO Box 68787 Seattle,WA 98168 INSURER(S)AFFORDING COVERAGE LiNAIL# INSURER A Travelers Insurance Company + INSURED INSURER B: L Clio Samia-Lindenauer, DDS INSURER C: i 1809 100th Pl. SE Suite A INSURER D. t Everett,WA 98208 INSURER E INSURER F: . COVERAGES CERTIFICATE NUMBER: 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. LTR INSD WVD;TYPE OF INSURANCE ` POLICY EFF POLICY EXP T 9H424490 .{MMID DrYYYY)l(MM/D D/YYW)I LIMITS A COMMERCIAL GENERAL LIABILITY Y POLICY NUMBER 1/3/2020 1/3/2021 EACH OCCURRENCE I$1,000 0_0_O_ INSR ADDL SUBRI DAMAGE TO RENTED - - - -, -CLAIMS-MADE a OCCUR ! I I PREMISES jEa occurrence) $300,000 ._ MED EXP(Any one person) $5,000 - ;. i 1 PERSONAL&ADV INJURY 1$Included GENT AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $2,000,000 ElPOLICY pJE4 EDLOC !. 1 PRODUCTS-COMP/OPAGG I$1,000,000 OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ (Ea accident)-_ ANY AUTO i l BODILY INJURY(Per person) $ OWNED "SCHEDULED AUTOS ONLY AUTOS i ; BODILY INJURY(Per accident) $ HIRED NON-OWNED rPROPERTY DAMAGE $ • AUTOS ONLY AUTOS ONLY •,_{Per accident UMBRELLA LIAR i ��OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE] ' AGGREGATE $ DED I I RETENTION$ j $ I I ' Y/N PER �OTH AND EMPLOYERS'LIABILITY STATUTE ER WORKERS COMPENSATION -.---- --r----- -------- ---- ! E.L.EACH ACCIDENT $li - OFFICE ory In NEREXCLUDED? N/A I E.L. ISEASE EA EMPLOYEE$ (Mandatory M yes,adteSry_In�NHder l ARTNER/EXECUTIVE ... _-._..._ EMPLOYEE — _--- _— I iDESCRIPTION OF OPERATIONS below I i iE.L.DISEASE-POLICY LIMIT l$ I i I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Dental Office at: 1809 100th PI. SE Suite A Everett,WA 98208 City of Everett, its officers, employees, and agents are additional insured. CERTIFICATE HOLDER CANCELLATION Cityof Everett, Its officers, employees, and a agents SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Additional Insured: ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD