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„---- <br /> ACcRD CERTIFICATE OF LIABILITY INSURANCE DATE 4r�tmrYY)12i1412fJ2(� <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THES <br /> IS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,T�END OR ALTER THE C©NTIZACT BETWEEN THER SSUING INSURER)AUTHC3RlZII=D <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poli $$)cme�nhpoli+�as�any require NAL SURED provisions or be endorsed- <br /> art endorsement A statement on <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, <br /> this certificate does not confer rights to the certificate holder In lieu of such e NAME: Lydia Lopeznd rsement(s). <br /> -PR <br /> PRODUCERTACT <br /> Mike Ramirez PHONE 425-$23-25gt1- <br /> StateFarmFAX �I25-+3498943 <br /> (AFC.No.Extl: OVC,No): <br /> dia nsure'stwlthmike.ccim <br /> 4809 132nd St SE Ste A103 A>DRESS: NAIL# <br /> 0y <br /> § Everett,WA 98208 INS131iEiSl AFFORDING COVERAGE 25i 43 <br /> INSURER A: State Farm Fire and Casualty Company <br /> INSURED <br /> INSURER B: - <br /> Chelsea Washington INSURER C: <br /> 7439 Beverly Blvd, INSURER D <br /> Everett,WA 98203-5722 INSURER E: <br /> — <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN�QNUr�C©�THE <br /> t'�THEI2 DOCUMENT WISURED NAMED TH H RESPECT T(]E FOR THE LICY WHICH RIDS <br /> INDICATED NOTVIIITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br /> INSURANCES AYFFORD BEENY THE <br /> PO BY PAID CLAIMS.DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITSPOLICY EFF POLICY EXP LIMITSILTR I TYPE OF INSURANCE ly AootAsuaa so i wyD POLICY NUMBER IAMIDDNYY'YI.CNIM/DDIYYY1 t ”X 1,{}p4,Og0 <br /> EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY EACH <br /> TO ReNTED <br /> PREMISES IEa occorence) $ <br /> I CLAIMS-MADE <br /> t�. OCCUR <br /> MED LAP(Any or persan) $ <br /> A X +98-83-F338-O 10105/2020 10106,2021 PERSONAL S ADv INJURY $ <br /> GENERAL AGGREGATE $ 2,�{]D,Dt10 <br /> I <br /> POLICY IX 118 I l LOC <br /> GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ <br /> -_ <br /> OTHER; COMBINED SINGLE LIMIT �; <br /> AUTOMOBILE LIABILITYEa accident) <br /> BODILY INJURY(Per person) $ <br /> ANY AUTO <br /> BODILY INJURY(Per accident) $ <br /> OWNED �SCHEDULED <br /> AUTOS ONLY .— AUTOS <br /> HIRED NON-OWNED Per PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY $ <br /> EAGtIpOCURRENCE # <br /> UMBRELLA LIAR OCCUR <br /> --� AGGREGATE S <br /> EXCESS LIAES CLAIMS-MADE !! �- <br /> $ « <br /> DED 1 RETENTION$ $TA UTE l <br /> WORKERS COMPENSATION 1 <br /> ER <br /> AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ <br /> ANY PRpPRLE70RlPARTNERIEKECUTIVE 1 NI#A E,L.pISEASE-EA EMPLOYEE,$ <br /> (MandaRIMEMBER L SCLUDEL? <br /> lMendat©ry In NH) �E.L.DISEASE-POLICY LIMIT�_ <br /> It yes,describe under OF OPERATIONSDESCRIPTION below <br /> DESCRIPTION OF OPERATIONS)LOCATIONS r VEHICLES (AcoRv tat,Additional Remarks Schedule,may be attached it more space Is required) <br /> CERTIFICATE HOLDER - <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> CITY OF EVERETT AUTHORIZED REPRESENTA ive <br /> 2930 WETMORE AVE. <br /> EVERETT,WA 98201 <br /> Q 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD taaaaas 132849.13 04-22 aolo <br />