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<br /> ,� I CERTIFICATE OF LIABILITY INSURANCE 5/12/2016
<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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACTNAME:
<br /> Britton-Gallagher and Associates,Inc. ffA//C,No.Ext1:216-658-7100 ivy.Ne):216 658-7101
<br /> One Cleveland Center,Floor 30 E-MAIL
<br /> 1375 East 9th Street ADDRESS:
<br /> Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Everest Indemnity Insurance Co. 0851
<br /> INSURED 18234 INSURERS:Everest National Insurance Company 0120
<br /> Western Display Fireworks Ltd. INSURER C:Axis Surplus Ins Company 6620
<br /> •
<br /> P.O.Box 932 INSURER D:Alaska National Insurance Company
<br /> Canby OR 97013 INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:965010432 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 /> ADDLSUBR POLICY EFF POLICY EXP
<br /> 1 TR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) IMM/DD/YYYY) LIMITS
<br /> A GENERAL LIABILITY SI8ML00215-161 1!15/2016 1/15/2017 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> xCOMMERCIAL GENERAL LIABILITY i PREMISES(Ea occurrence) $500,000
<br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $
<br /> PERSONAL&ADV INJURY _$1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
<br /> POLICY >1—(--PRQ ^LDC COMtiINtO SINGLE UMI'!
<br /> $
<br /> B AUTOMOBILE LIABILITY SI8CA00098-161 1/1E/2015 1/15/2017 (Ea accident)
<br /> $1 000,000
<br /> X ANY AUTD _ BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS —AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> X HIRED AUTOS X AUTOS (Per accident) _
<br /> $
<br /> C UMBRELLA LIAB X OCCUR EAU784636 1/15/2016 1/15/2017 EACH OCCURRENCE $4,000,000
<br /> X EXCESS LIAB CLAIMS-MADE _AGGREGATE $4,000,000
<br /> DEO RETENTION$ $
<br /> A WORKERS COMPENSATION SI8ML00215 161 1/15/2016 1/15/2017 WC TRY LIMITS X OER Stop Gap
<br /> AND EMPLOYERS'LABIUM' Y/N ,
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA EL EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory In NH) EL DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,descnbe under EL DISEASE-POLICY UMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> D Washington USLH 15DWU08933 4/16/2016 4/16/2017 BI by Accident $1,000,000
<br /> BI by disease policy limit$1,000,000
<br /> El by disease Each Empioyee$1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is.required)
<br /> Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement
<br /> Display Date:7/4/16
<br /> Display Site: Barge located 850 feet of Jetty Island, Everett,WA 98201
<br /> Additional Insured:
<br /> City of Everett,its officers,employees,and agents
<br /> See Attached...
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Everett Fourth of July Foundation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 2930 Wetmore Ave.,Suite 10-A ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett WA 97201
<br /> AUTHORIZED REPRESENTATIVE
<br /> 411ft. Thi
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<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> -
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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