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AC�® DATE(MM/DD/YYYY) <br /> ii,.... CERTIFICATE OF LIABILITY INSURANCE 4/19/2022 <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 t:UNIACT NAME: Jackie Jun <br /> PHONE FAX <br /> Ace Insurance&Retirement Svc Inc A/C No,Ext): (425)999-7860 (A/C,No): <br /> 3301 184th St SW Ste 115 ADDRESS: jackie@aceinsus.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Lynnwood WA 98037 INSURER A: Ohio Security Ins Co 24082 <br /> INSURED INSURER B: <br /> Primecom USA LLC/Primecome Solutions Inc INSURER C: <br /> 22717 72ND AVE S INSURER D: <br /> INSURER E: <br /> KENT WA 98032 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 AIJUTYPE OF INSURANCE INSD 1 POLICY NUMBER POLICY❑H- POLICY LX,YY LIMITS <br /> LTR INSD WVD (MMIDDMlYY) (MMIDDIYYYY) <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 <br /> MED EXP(Any one person) $ 15,000 <br /> A A BKS64203672 12/01/2021 12/01/2022 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO LOC 2.000,000 <br /> PRO- <br /> JECT PRODUCTS-COMP/OP AGG $ <br /> OTHER: <br /> AUTOMOBILE LIABILITY eUMBINED SINGLE LIMI I $ 1,000,000 <br /> (Ea accident) <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> A -AWNED -SCHEDULED AUTOS ONLY AUTOS BAS64203672 12/01/2021 12/01/2022 BODILY INJURY(Per accident) $ <br /> -HIRED -NON-OWNED PROPER I Y DAMAGE. $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5.000,000 <br /> A EXCESS LIAB CLAIMS-MADE US064203672 12/01/2021 12/01/2022 AGGREGATE S 5,000,000 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION HER 01 H- <br /> AND EMPLOYERS'LIABILITY Y/N X STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 <br /> A OFFICER/MEMBER EXCLUDED? N/A WA STOP GAP BKS64203672 12/01/2021 12/01/2022 1.00Q000 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> 72nd Ave S Ste#B 101 Kent WA 98032. <br /> City of Everett,2930 Wetmore Ave.,Suite 9E Everett,WA 98201 is added as additional insured. <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 /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2930 Wetmore Ave., AUTHORIZED REPRESENTATIVE <br /> Suite 9E ja,,.(t.{,@,_,j VI,Vt <br /> I 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 />