|
lr "41 ELCOASS-01 JMOSLE
<br /> A COREY DATE(MMIDDIYYYY)
<br /> f CERTIFICATE OF LIABILITY INSURANCE 5/5/2022
<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 CONTACT
<br /> NAME:
<br /> Leonard Adams Insurance,Inc. PHONE FAX
<br /> 5201 SW Westgate Dr#300 (ArC,No,E:t):(503)296-0077 1(A/c,No):(503)296-0044
<br /> Portland,OR 97221 o A SS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC S
<br /> INSURER A:Hartford Casualty Ins.Company 29424
<br /> INSURED INSURER B:Hartford Insurance Co.(ppe) 19682
<br /> Elcon Associates,Inc. INSURER C:Admiral Insurance Company 24856
<br /> 15220 NW Greenbrier Pkwy.#380
<br /> Beaverton,OR 97006 INSURER D:
<br /> Portland,OR 97229 INSURER E:
<br /> 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 VNTH 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 ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS
<br /> LTRINSD WVD (MMIDD/YYYYI IMM/DDIYYYYI
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 52SBAUJ9517 11/1/2021 11/1/2022 DAMAGE TO RENTED
<br /> PREMISES(Ea occurrence) $
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X JECOT LOC PRODUCTS-COMP/OP AGO $ 2,000,000
<br /> DTHER: WA Stop Gap $ 1,000,000
<br /> A AUTOMOBILE LIABILITY CEOM�BIINEEDiSINGLELIMIT $ 1,000,000
<br /> - ANY AUTO 52SBAUJ9517 11/1/2021 11/1/2022 BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOSR��ONLY AUTOS
<br /> y� BODILY INJURY(Per accident) $-___
<br /> X AUTOS ONLY X AUTOS ONLY (I er accident)AMAGE $
<br /> $
<br /> A X UMBRELLALIAB X I OCCUR 10,000,000
<br /> _ EACH OCCURRENCE $
<br /> EXCESSLIAB CLAIMS-MADE 52SBAUJ9517 11/1/2021 11/1/2022 AGGREGATE $
<br /> DEO X RETENTIONS 10,000 $ 10,000,000
<br /> B WORKERS COMPENSATION X I STATUTEI 1 OOTH
<br /> AND EMPLOYERS'LIABILITY PER
<br /> ER
<br /> Y/N 52WECPR6207 11/1/2021 11/1/2022 1,000,000
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> FFICERIMEMB R EXCLUDED? N I A
<br /> (Mandatory in NEH) E.L.DISEASE-EA EMPLOYEE.$ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT $
<br /> C Prof.Liability E0000044585.05 5/6/2022 5/6/2023 Each Claim 5,000,000
<br /> C Professional LiablII E0000044585-05 5/6/2022 5/6/2023 Aggregate 5,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I1 more space is required)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> of EverettTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City
<br /> Attn:Vincent Bruscas ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 3201 Smith Ave,Suite 215
<br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|