5 Rivers LLC dba 5 Rivers Indian Cuisine 12/21/2020

A CO-'--7-RIF, . DATEIM CERTIFICATE OF LIABILITY INSURANCE 12/1 24 THIS CERTIFICATE I5ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DONS NOT AFFIRMATIVELY OR NEGATIVF„LY IAMEND,EXTEND OR ALTER THE CODE AFFORDED BY THE POLIO E3 BELOW.THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUtIER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND TM CERTIFICATE IFICATE HOLDER. , IM ORTAIVT:lithe certificate holder is an AD MONALINSURIED,thepoiiy(iea)must►wveADornosALINSUREDprovisionsorbarendorsed..IfSUBRO.GATONI5 WAIVED,subject to the terms and�`g renditions of the policy,certain polities may require an endorsement.A gof such endorsement(s). statement on this certificate does not confer rights to the certificate holder in lieu tr CONTACT NAME: Kiran Sharma(792636R) PHONE (A/C,NO,EXT):425-$38-4148 (A/C.NO):425-953.44�(3 FAX 9629 Evergreen Way Ste 203 A _ , ...... E-MAIL ADDRESS: icsharmal @farmersagent.coml Everett WA 98204-7169 INSURER(S)AFFORDING C RAGE NAIC# 'INSURED INSURER A: Truck Insurance Exchange < .s. 21709 INSURERS: Farmers Insurance Exchange 21852. 5 RIVERS Indian Cuisine LLC INSURER c: Mid Century Insurance Company . 21687 9629 EVERGREEN WAY STE 201 INSURER D INSURER E: EVERETT WA 98204 , . .:., INSURER F: i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ______— I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEDLQW BeHAVE SEEN ISSUED TO THE INSURED NAME ABOVE FOR THE.POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED I3Y TI IE. POUCEES DESCRIBED HEREIN IS SUF)ECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POUCJES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADOTL I BURR POLICY NUMBER POLICY EFF POLICY> kiIVIITS LTR TYPEOPINSURAN E INSO WV') (MI iDD/YVYY) (MPA/QED/YYYY3 , X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE $ I,000,00 b ERENTED CLAIMS-MADE OCCUR $ PREmises( aOcL 75,000p : r MENr EXP<Anyoneperson) $ .5;00l A Y Y 606749214 46f17/2Q2(3 96117 Q29 ERSOtiA&,&ADVI Nu 5 1,4A0000 GE Nei.AGGREGATE LIMIT APPLIES PERT I GENERAI..AGGREGATE= $ 2,000 nrin X lt3LtGY i.I""` PRQ)ECi° Ltd PRODUCTS-I PRODUCTS-COMP/OP AGG $ 2,000,000 I m OTHER: $ COMBINED SINGLE LIMIT $ 1 AUTOMOBILE UABIi~ITY ;Es accident) III ANY AUTO BODILY IN)t3RY(Prat Person) S OWNEDAUTOS SCHEDULED BODILY INJURY(Per accident)S ONLY AUTOS N ' w , HIRED AUTOS NON-OWNED I PROPERTY DAMAGE $ ONLY I AUTOS ONLY (Per accident) UMBRELLA LUAB OCCUR t EACH OCCURRENCE $ II EXCESS LAB CLAIMS-MADE: AGGREGATE ..�...S •.. DELI RETEN°11ON$ $ , WORKERS COMPENSATION PER------rIOTHER $ AND EMPLOYERS'LI1rE311 tTY STATUTE f ... ANY PRO pRIETQR/PARTNER/ V/N I I E;L.EACH ACCIDENT $ EXECUTIVE OFRcERI MEMBER N/A - E.L.DISEASE�EA EMPLOYEE EXCLUDED?(Mandatory in NH) A .. I1yes,d�,.. cvlbe umitr DESCRIPTION Of F.L.DISEASE•POLICY LIMIT $ C}PERATj43N5heIcYw _ DESCRIPTION OP ORERATIONS/LOCATIONS/VEHICLES(ACCRO 101.Additional Remarks Sclr h.may Ears attached If More apt ui rr gwied) 29 EVERGREEN WAY STE 201,EVERETT,WA 98204 The Certificate Holder is naming the City of Everett,its officers,emMoyees and agents as additional ineured for the duration of the program is required, The City of Everett accepts a wide variety of a additional insured" endorsements,SO your insurance provider can create a form or provide the form he/she/they works/work With regularly. CERTIFICATE HOLDER CANCEE.LATIO1 CIITY OF EVER TT I SHOULD ANY Of TREASON DESCRIBED PO ES as CANCEU.ED BEFORE THE EXPIRATION 2930 WETMORE AVE DATE resesoF,Kona WILL BE DELIVERED IVE RED IN ACCORDANCE WITH THE POLICY PROVISIONS. IS. , , STE 100 AUTHORIZED D RIIIPRESENTA11VE . EVFRFTt ..,. WA.98231 n. ACORD 26(2016/03) 01988-2015 ACORD CORPORATION.All Rights Rased z t_,7F.R 1 t_1 C The ACORI)nem*end loon Are racaieter'od merle%of ACOR0