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l N A ATE MAIVDO VYYY) <br /> D <br /> VCORD CERTIFICATE OF LIABILITY INSURANCE 1,t09n020 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ics)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> terms and conditions of the policy.certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER ACI <br /> SEAN JOYNER INSURANCE AGENCY C N 4p5315 9300 FAX <br /> 9999 Harbour Place#103 EcAudtINC.NO Fdl- '�`'� <br /> AaoRcss_ <br /> Lii.f_Hilk."— Mukilteo,WA 98275 PRODUCER <br /> RrsuRea wrfORomo COVERAGE wut s <br /> slmm pisuReR .State Farm Fire and Casualty Company 25143 <br /> ETHERINGTON, KARY L& SHELLEY R INSU R B <br /> dba ALLEGRO DANCE STUDIO MWSURER C. <br /> 2615 W Casino Rd. Suite 38 eisuRER o <br /> Everett,WA 98204 INSURER E i , <br /> INSURER F• <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ <br /> THIS IS TO CI RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCXICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE: TERMS. <br /> I.XCI USIONS AND CONDITIONS OF SUCH POI ICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> Pew' Ttii6L POUtY is ; POUCY EXP <br /> M <br /> LTR, TYPE OF BtMANCE _ isR itrvn POLICY NwuER — useTS <br /> A GENERAL UABILtIY EAcs nr:CURRENrE S 1.000.000 <br /> X r0VVERCUK GENERAL t IAD l re pR f J1 c et }S <br /> CLAILISdAADE X ^occurs Y I �.� 65-5 11/2372019 i 11/2312020 FXP rAry one owoanf I$ <br /> 10,000 <br /> j PERSONAL&AOV INJURY S 1,000,000 <br /> X Blanket Coverage GENERAL AGGREGATE S 2.000.000 <br /> GEN".AGGREGATE.IMIT APO:IFS PER PROOUCT$-COAIPIOP Ann_S 2.000,000 <br /> X POLICY ]TA [ Loc Blanket Coverage s 48,000 <br /> AUTOMOelLE UAaa1tY cONONED SINGLE LIWIt s <br /> 1 tcu saaax+u <br /> 'ANY AUTO <br /> -Ai..OIYNEJ AUTOS BOOBY INJURY INK 0M!so^1 S <br /> •SCHEDULED AJTaS DAMAGE S <br /> IIOOIL Y INJURY(i' sxdont: $ <br /> PROPERTY <br /> HIRED AUTOS 1�scowl) <br /> NON O YNEC AUTOS S <br /> 1 S_ <br /> —--—. <br /> UMB tRELLA S : occult [rncn occuRrsndcc <br /> EXCESS L AS _ a,uus.&iADE 1 AGGREGATE $ <br /> , <br /> DEDUCTIDL: 1 S <br /> RETEN'IO`. S S <br /> WORKERS COr/EN'iATHON --- + t WC STATU- I tail- <br /> AND EMPLOYERS'UABIITY lob lite..21 LS . , <br /> 1 ANY PROPRETOR.PARTNERJEXECLETIVE r 1 N p l E.L EACd1 AT-II/ENT $ <br /> i COMER/MEMBER ExcLu0EDT LJ 111 N r A <br /> : - <br /> i . rule. <br /> E.L.0iSEASt-EA EMPLOYEE S <br /> I& ' tN In, - i i.L.DISEASE-PQ ICY LIMIT I$ <br /> L OD <br /> DESCRIPTION Of OPERATIONS 1 LOCATIONS f VEHICLES(ASad9 ACORD 101.Additional RrnaAoc Sehsdds.If mini spars Is rsqu ef) <br /> i <br /> i <br /> CERTIFICATE HOLDER CANCELLATION <br /> Additional Insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN ACCORDANCE WITH INC <br /> Economic Development Department POLICY PROVISIONS. <br /> City Of Everett <br /> 2930 Wetmore Ave,Suite 10A AUTHORIZED REPRESENTATIVE <br /> Everett,WA 98201 <br /> • t 1 ). <br /> �i / `� / , <br /> 0198w-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02-11-2010 <br />