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DATE(MM1DD/YYYY) <br /> A�RD� CERTIFICATE OF LIABILITY INSURANCE 12/14/2020 <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 POLICIES <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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the 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 NAME CTAnnie Le Insurance Agency,Inc. <br /> Annie Le, Agent PHONE — FAX <br /> State Farm Insurance (AIC,No,Ext):425-7$7-430D _^ (A/C,No):425-787-4338 <br /> StateFarm AADDRESS:annie.ie.mtzy@statefarm.com <br /> 19520 66th Ave WCD <br /> WA 98036 INSURER(S)AFFORDING COVERAGE NAIC# <br /> o-p Lynnwood, <br /> INSURER A:State Farm Fire and Casualty Company 25143 <br /> INSURED Anh Nguyen INSURER B: <br /> DBA Angel Hair& Nails INSURER C: — <br /> 4823 Evergreen Way INSURER D: <br /> Everett, WA 98203 INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR BR <br /> TYPE OF INSURANCE ADDL SU POLICY EFF POLICY EXP/Y LIMITS <br /> LTR INSD WVD POLICY NUMBER (MMIDDYYY) (MM)DD/YYYYj <br /> A COMMERCIAL GENERAL LIABILITY 98-BH-W260-5 03/02/2020 02/02/2021 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ <br /> MED EXP(Any one person) $ 5,000 <br /> X Business Insurance PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NO OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS _(Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ERH _ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Reference:SWAM1488BLTD//NA02 <br /> CERTIFICATE HOLDER CANCELLATION <br /> Addtional insured: <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> The City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> including itts officers, employees, agents ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett,WA <br /> AUTHORIZED REPRESENTATIVE <br /> 01988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1001486 132849.9 02-04-2014 <br />