Laserfiche WebLink
® DATE(MWDD/YYYY) <br /> ACCORD CERTIFICATE OF LIABILITY INSURANCE <br /> 12/15/2020 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: Jennifer Jones <br /> Scott M. Campbell PHONE FAX <br /> PO Box 1658 (A/C.No,Ext): (425) 775-6446 (A/C,No):(425) 640-9225 <br /> E-MAIL <br /> Edmonds WA 98020 ADDRESS: info@insuranceservicesgroup.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:Ohio Security Insurance Company 24082 <br /> INSURED (360) 420-4558 INSURERS: <br /> Grace & Blooms Floral Design <br /> INSURER C: <br /> 2829 Wetmore Ave INSURERD: <br /> Everett WA 98201 INSURER E_ <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:Cert ID 4470 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 /> !NSWTYPE OF INSURANCE ADDL SUBR _ POLICY EFF I POLICY EXP LIMITS <br /> LTRINSD WVD POLICY NUMBER (MM(DD/YYYY)f IMM/DD!YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 2,000,000 <br /> DAMAGERENTED <br /> CLAIMS-MADE X j OCCUR Y BZS60988677 02/13/2020 02/13/2021 PREMSESO(Eaoccurrence) $ 2,000,000 <br /> MED EXP(Any one person) $ 15,000 <br /> { PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 <br /> POLICY PRO- <br /> JECT I LOC PRODUCTS-COMP/OPAGG $ 4,000,000 <br /> OTHER: <br /> AUTOMOBILE LIABILITY -COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident) <br /> A ANY AUTO BAS60988677 02/13/2020 02/13/2021 BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> X AUTOS ONLY X AUTOS ONLY (Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTION$ $ <br /> WORKERS COMPENSATIONOTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUDED? NIA �'- <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 /> 1$ <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> Certificate holder is additional insured on the general liability. Endorsement to be issued by <br /> carrier. <br /> CERTIFICATE HOLDER 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 <br /> 2930 Wetmore Avenue AUTHORIZED REPRESENTATIVE <br /> 4a hflk)4' <br /> Everett WA 98201 ' <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> Page 1 of 1 <br />