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,- ® DATE(MMIDD/YYYY) ,acoRo CERTIFICATE OF LIABILITY INSURANCE 4/19;2022 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: Jackie Jun PHONE I-AX Ace Insurance&Retirement Svc Inc AIC No,Ext): (425)999-7860 (A/C,No): 3301 184th St Sw Ste 115 ADDdRESS: Jackie@aceinsus.com INSURER(S)AFFORDING COVERAGE NAIC# Lynnwood WA 98037 INSURER A: Ohio Security Ins Co 24082 INSURED INSURER B: Primecom USA LLC/Primecome Solutions Inc INSURER C: 22717 72ND AVE S INSURER D: INSURER E: KENT WA 98032 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. IN,R •TYPE OF INSURANCE •• SOeK —POLICY NUMBER POLICY EFF POLICY EXP - LIMITS LTR INSD WVD (MM/DDIYYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I,000,000 UAMAbt I V KtN I LU 1,OOQ000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 A A BKS64203672 12/01/2021 12/01/2022 PERSONAL RADVINJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,)00 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMI I $ 1.00000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A AWNED —SCHEDULED AUTOS ONLY AUTOS BAS64203672 12/01/2021 12/01/2022 BODILY INJURY(Per accident) $ —HIRED —NON-OWNED PROPER I Y UAMAC,E $ AUTOS ONLY AUTOS ONLY (Per accident) $ - X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000.000 A EXCESS LIAB CLAIMS-MADE US064203672 12/01/2021 12/01/2022 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ER UIIH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT S 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A WA STOP GAP BKS64203672 12/01/2021 12/01/2022 I,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,00Q000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 72nd Ace S Ste#B101 Kent WA 98032. City of Everett,2930 Wetmore Ave.,Suite 9E Everett,WA 98201 is added 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 City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore Ave., AUTHORIZED REPRESENTATIVE Suite 9E Jt3,,ki _.,rr; ,vxf 1 Everett WA 98201 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD