After Image Syling Salon 12/28/2020

1 ® DATE(NIMIDDIYYYY) A () CERTIFICATE OF LIABILITY INSURANCE 12r17/2o20 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and 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(sl. PRODUCER CONTACT BILL HOLT,AGENT NAME: S t 3 ""_T STATE FARM INSURANCE PHONEy sw; e~.na n t,§ 360-568$505 FAX i.Fn BILL HOLT,AGENT E-MAIL ADDRESS: PO BOX 130 INSURERS)AFFORDING COVERAGE NAIC# _ SNOHOMISH WA 98291 INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER B: DOUGLAS,KIM INSURER C: _ DBA:AFTER IMAGE STYLING SALON INSURER D: 2114 CEDAR RD INSURER E: LAKE STEVENS WA 98258-8448 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR i TYPE OF INSURANCE ADD!..SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WV() POLICY NUMBER (MM/DD/YYYY) (hi_M/DD/YYYY] COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i$ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE J OCCUR PREMISES Ea occurrence) $ 300,000 X BUSINESS POLICY MED EXP(Any one person) $ 5,000 __ A I X 98-GY-2825-6 02/15/2020 02/15/2021 PERSONAL&ADV INJURY $ ��GEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY E k 1 LOC PRODUCTS-COMA/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N I A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ BUSINESS POLICY A X 98-GY-2825-6 02/15/2020 02/15/2021 BUSN PROPERTY $43,500 1 o I DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) LOCATION:2810 COLBY AVE,EVERETT,WA 98201 The City of Everett its officers,Employees and Agents are listed as Additional Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF EVERETT AUTHORIZED REPRESENTATIVE J/ f J / 1 (- ACORD1-1 25{zo�s�v3� ©1988..2415 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04-22-2020