Thai Valley Restaurant 3/2/2021 - Laserfiche WebLink

• ACC)RE)® DATE(MM/DD/YYYY) • ... CERTIFICATE OF LIABILITY INSURANCE 02/19/2021 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(s). PRODUCER CONTACT NAME: Mai Giron(790334V) PHONE FAX 1120 164th St SW Ste I (A/C,NO,EXT):425-599-1641 (A/C,NO):866-210-4404 E-MAIL Lynnwood WA 98087-8190 ADDRESS: mgiron@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 THAI VALLEY INC INSURER c: Mid Century Insurance Company 21687 7415 HARDESON RD STE C INSURER D: INSURER E: EVERETT WA 98203 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 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 TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea Occurrence) $ 75,000 MED EXP(Any one person) $ 5,000 C Y Y 605500390 12/10/2020 12/10/2021 PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PROJECT LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS SCHEDULED BODILYINJURY(Peraccident)$ ONLY AUTOS N HIRED AUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ V/N E.L.EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER N/A E.L.DISEASE-EA EMPLOYEE $ EXCLUDED?(Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 7415 HARDESON RD STE C,EVERETT,WA 98203 THE CITY OF EVERETT IT'S OFFICERS EMPLOYEES AND AGENTS ARE NAMED ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF EVERETT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 2930 WETMORE AVE DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. STE 8A AUTHORIZED REPRESENTATIVE MAI GIRON EVERETT WA 98201 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD