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itte,,,:mco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 8/15/2021 8/11/2020 <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 Lockton Companies NAMEcontract <br /> 444 W.47th Street,Suite 900 PHONE FAX <br /> INC <br /> Kansas City MO 64112-1906 CO Ertl: 'NO)' <br /> (816)960-9000 ADDRESS: <br /> INSURER'S)AFFORDING COVERAGE NAM* <br /> INSURER A:Valley Forge Insurance Company 20508 <br /> INSURED KDW Salas O'Brien,LLC INSURER B:National Fire Insurance Co of Hartford 20478 <br /> 1441719 do Salas O'Brien Holdings,Inc. INSURER C:Continental.Casualty Compan,y , 20443___ <br /> 3700 South Susan St,Ste 150 INSURER D:The Continental Insurance Company 35289 <br /> Santa Ana CA 92704 <br /> INSURER E: <br /> INSURER F: <br /> .COVERAGES SALOB01 CERTIFICATE NUMBER: 15552862 REVISION NUMBER: XXXXXXX <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 TYPE OF INSURANCE AWL SUBR! POLICY EFF POLICY EXP <br /> LTR tNSD WVD POLICY NUMBER IMMID!YYYYYYl (MMIDD!'ITYY): UINTS <br /> D X _COMMERCIAL GENERAL LIABILITY Y N 6050432756 8/15/2020 8/15/2021 EACH OCCURRENCE $ 1000 000 <br /> RENTED <br /> DAMAGE Id s k._ <br /> CLAIMS-MADE X OCCUR PREMISES(Ee occurrence) ,$.300.000, <br /> MED EXP(Any one person) #$ 15,000 <br /> PERSONAL&ADV INJURY $ 1 000.000 <br /> GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2.000.000 <br /> POLICY X JECOT- LOC PRODUCTS-COMP/OP AGG $ 2.000,000 <br /> OTHER: $ <br /> D AUTOMOBILE LIABILITY Y N ' 6050475025 8/15/2020 8/15/2021 coMBwED SINGLE LIMIT Ifs accident) $ <br /> ANY AUTO BODILY INJURY(Per person) $ XXXXXXX <br /> OWNED ---"'SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS XXX�IXXX <br /> HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX <br /> _ AUTOS ONLY ! AUTOS ONLY .(Per accident <br /> $ XXXXXXX <br /> UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ XXXXXXX <br /> !DED 71 RETENTION$ $ XXXXXXX <br /> WORKERS COMPENSATION NPt:R H <br /> A AND EMPLOYERS'LwBILITY 6050520979(AOS) 8/15/2020 8/15/2021 X STATU ER <br /> TE , <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA 6050432742(CA) E. <br /> 8/15/2020 8/15/2021 L.EACH ACCIDENT $ 1,000 QOQ <br /> OFFICER/MEMBER EXCLUDED? a <br /> (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1.000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1.000.000 <br /> C PROFESSIONAL N N ': AEH591877402 8/15/2020 8/15/2021 $1,000,000 PER CLAIM/AGG. <br /> LIABILITY <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> RE:CITY OF EVERETT,ITS OFFICERS,EMPLOYEES AND AGENTS ARE ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND <br /> AUTO LIABILITY,AND THESE COVERAGES ARE PRIMARY AND NON-CONTRIBUTORY,AS REQUIRED BY WRTTTEN CONTRACT.THIRTY(30) <br /> DAYS NOTICE OF CANCELLATION BY THE INSURER WILL BE PROVIDED TO THE CERTIFICATE HOLDER,TEN(10)DAYS NOTICE IN THE <br /> EVENT OF NONPAYMENT OF PREMIUM. <br /> CERTIFICATE HOLDER CANCELLATION See Attachments <br /> 15552862 <br /> CITY OF EVERETT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> CEDAR STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 3101 <br /> 3101 T WA 98201 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> EVEAUTHORIZED REPRESENTAT ? <br /> 1 <br /> AT 7 <br /> 0 1988 015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2015/03) The ACORD name and logo are registered marks of ACORD <br />