Slyders LLC dba Totem Family Diner 11/30/2020

ACC I3R ® L.,. CERTIFICATE OF LIABILITY INSURANCE i DATE(MM/DD/YYYY) 11/21/2018_ 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(is)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED,subject to the terms and-1 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: Laura Villalobos Stacey Scott(793737E) PHONE 1 FAX 14522 NE N Woodinville Way Ste 205 (A/c,NO,EXT):425-481-1430 I(A/c,No):425-671-2011 E-MAIL Woodinville WA 98072-6427 ADDRESS: Laura@madisonaveins.com INSURER(S)AFFORDING COVERAGE ! NAICS INSURED INSURER A: Truck Insurance Exchange I 21709 INSURER B: Farmers Insurance Exchange 21652 SLYDERS LLC INSURER c: Mid Century Insurance Company 21687 dba Totem Family Diner --- INSURER D: 4410 RUCKER AVE I EVERETT WA 98203 INSURER E: ^� , INS---- -- i INSURER T. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI,SISTOCERTIFYTHATTHEPOLICIESOFINSURANCEUSIEDSEOL'.'HAVEBEENISSUEDTOTHE!NSURED IAMB ABOVE FOR THE POLICY PERIOD INDICATED.HOTWITHSTANDINGANT REQUIREMENT,TERM OR CONDITION OF ANYCONTRACT OR OTHER DCCUMEN I VVI IH RESPEG r 10 WHICH THIS CERTIFICATE MAY BE ISSUED OR.MAY PERTAIN.THE INSURANCE AFFORDED G'r THE i3OLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDEN3NS OF SUCH POTICIE L fallS SHOWN MAY HAVE BEENREDUCEDBYi'AID CLAIMS . INSR 1 I I ADDTL SUER ' POLICY EFF POLICY TYPE OFINSURANCE POLICY NUMBER LIMITS INSD WVD MMiDD/YYYY MM/DD/YYY - Xi COMMERCIAL GENERAL LIA6ILITY _ LACH1,000,000* �T i ' - T I Ci I I - 1 X ii } L__i i PREMISES a.x ncc, _ 250—_i -- I I ME!'PIP(Any anereracn; 5,000 C • Y ;605059370 ' 12/28/2019 i 12/28/2020 ! PERSONAL SADV,N;URI 1.• 1,000,000! G AD n E LO'I APPLIES PER: - I -+:E ..� -E ,000 _ PE` _ 2.000,000. X 2.000.000 AUTOMOBILE LIABILITY DO:u.I Li I 0 u6:r 1,000,000' (Ea;lecithin!?. - I ! I ANY AC ID BODILY I I)LIRY(Per Eersan) !`- i OWNED C I I X SC�E7L LEU ONLY ALTOS .,o .I ;NI L ..;pe a 605059370 12/28/2019 12l28/2020 I — X I FIRED Nl,1OS X I ',C r 1 D 1 ! { Pt G'E IT✓-....aL L—: ACT s_ L. u. .1 r— i I I iI I ttt 1= I UMBRELLALIAD __I OCCUR EACH OCCURRENCE —_--.Ii EXCESS LIAR ' C_r,.., -'.IAOL I 'A.C1GREGATE � ;-1 L ti;t S WORKERS COMPENSATION I ! I ! • i'E 2 AND EMPLOYERS'LIABILITY OTHER I ! STATUTEi, ANY PROPRIETOR/PARTNER:' 'vri I E.LEACH I EXECUTIVE OFFICER/MEMBER EXCLUDED'(Mandatory in NH) I `J N/A i f I F.l. U!Srr:So EA E fLO-. :.- S .1 If yes.describe turrl'r DESCRIPTION OF ! OPERATIONS ibeim, D!SE I 1 ! , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Location:4410 RUCKER AVE,EVERETT,WA 98203 !The City of Everett.its officers,employees and agents as additional insured CERTIFICATE HOLDER CANCELLATION City of Everett -- —— — ---� SHOULD ANY9E4rAsoE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION 2930 Wetmore Ave j DATE THERE CBS'IILL3EDLIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. • — Ste 10A Au Iz T FvPfett WA 98221 ACORD 25(2016/03) f,j �1988-2015 ACORD CORPORATION.All Rights Reserved 31-1 69 i-I S The ACORD name and logo are registered marks of ACORD