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+ �' CERTIFICATE OF LIABILITY INSURANCE DATE(NWDOrYYYY)03/29/2016 <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 INSURERS), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyfres)must be endorsed. If SUBROGATION IS WAIVED,subject to the <br /> tense 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 /> CONT <br /> 1*°DUCER NORTHROP INSURANCE AND FINANCIAL NAME ALYSSA GOLKA _ <br /> SERVICES, INC. (NNONC.No.Es&42.5-35.01 I MC,teo 425-314-6078 <br /> StadeFarm 10930 4TH AVE W e ALYSSA@NORTHROPIN4SURANCENET . <br /> INSURER(S)AFFORDING COVERAGEIDUC <br /> AO. EVERETT,WA 98204 INSURER A:State Farm Fire and Casualty Company 25143✓ <br /> Iasu+aen ROXANA ROROUJERDI DBA FUN TIMES ICE �IRSIIRHtB: <br /> CREAM IeSURraC: __ _. <br /> INSURER O <br /> INSURER E: <br /> INSURER F 7 <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES C* INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTINTHSTANDING 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 /> - POLICY POLICY EFF POLICY EXP <br /> IRR I TYPE OF INSURANCE .- i i.Wll III .ii tach/ I Leers <br /> ': 7. ,lit POLICY IHIi�Eir <br /> A GENERAL UA IJTY a El 98CCV3125 03/2912016 03/29/2017 EACH OCCURRENCEDIINIATOTIERTED $ 2,000.00© <br /> X COMMERCIAL GENERAL LIABILITY ISES(F ) $ 300.000 <br /> IDimes max I J OCCUR MED EXP(Anil one Person) $ 5.000 <br /> PERSONAL a MN INJURY s <br /> I GENERAL AGGREGATE $ 4,000,000 <br /> CEN/.AGGREGATE LIMIT APPLES PEFtPRODUCTS•CONIPICIP AOC 1 4,000,000 <br /> .,/ <br /> /� I POLICY I I/ECT LOG 3' <br /> B AUTOMOBILE LABILITY 'E— 7854359 0312812016 03/28/2017 (FaCOMaal0ent}81NE0 SINGLE LOOT i 2.000.000 <br /> ANY AUTO `---1 BOOlY INJURY(Rei parson) $ <br /> ALL DAMNED I y I SCHEDULED BODILY INJURY t Par am—(FM) s <br /> AUTOS II AUTOS IANED PROPERTY OAMAGG y <br /> HIRE AUTOS I A OS (Perixrdm) .. S <br /> UMBRELLA LIAO' t OCCUR T-11 1 EACH}CCU CE s <br /> AGGREGATE s <br /> exc:Ess LIA6 ClJVm15-1�°1bE j i <br /> DEO I RETENTIONS $ <br /> WORKERS COS1PEtWSATION , STATU- OTH <br /> AND EMPLOYERS'LIABILITY y I I?DUTY LOOTS I I ERR. <br /> ANYPROPRIETONIP,RTNERIEXECUTIVE Yr RI rifA4 I _ELEACH ACCIDENT $ <br /> OFF-ICENErBER EJtCLuDEL17 I I - <br /> olmnihxy N NN) I F L OISEA%-EA FWLO . $ _.. <br /> It yes.des> Ibo undue 1 EJ_DISEASE-POLICY MUTf <br /> _LIFSCRIPTT(,N fF:1PcRATlf)NS natrno `r. <br /> I II <br /> OESCSWTION cc OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORO tor,AuEGonal Remarks.Schedle,itawe space is reqilred) <br /> CERTIFICATE HOLDER CANCELLATION <br /> EVERETT PARKS&RECREATION SHOULD ANY OF THE ABOVE DESCRIBED P• a i- BE CANCELLED BEFORE <br /> THE EXPIRATION DATETHEREOF, NO . WILL BE DELIVERED IN <br /> 842 E.MUKILTEO BLVD ACCORDANCE WITH m -l• CV PROVISION <br /> EVERETT,WA 98203 <br /> Ai <br /> , ,.� <br /> C.4116.-411116- <br /> . <br /> 01988-,i10 :CORD CORPORA r'IN. All rights reavrved. <br /> ACORD 2$(2010/05) The ACORD name and logo are registered marks of •RD 1001486 132849.8 01.23-2013 <br />