Platinum Nine Holdings LLC dba NW Ambulance 7/19/2016

A 0® CERTIFICATE OF LIABILITY INSURANCE Dnre(MM/6/15/2016 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 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: Cindy Elbert Insurance Services Inc PHONE 602-942-3900 I FAX 602-942-4300 15182 North 75th Ave, Ste 100 E-MAILo Extl: IAIC,Not: Peoria,AZ 85381 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Markel Insurance Company 38971 INSURED INSURER B: Platinum Nine Holdings, LLC INSURERC: Northwest Ambulance INSURER D: P.O. Box 384 INSURER E: Arlington, WA 98223 INSURER F: COVERAGES CERTIFICATE NUMBER: 7,795 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY MTK70002677-02 8/19/2015 8/19/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED A PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5000 UProf. Liability PERSONAL&ADV INJURY $ 1000000 Stop Gap GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3.000 000 POLICY( � LOC $ AUTOMOBILE LIABILITY MTA70002677-02 8/19/2015 8/19/2016 Ee aBciderodSINGLE LIMIT $ 1,000,000 1 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X PROPERTY DAMAGE HIRED AUTOS NON $ X AUTOS-OWNED I (Per accident) $ UMBRELLA LIAB X OCCUR MTU70002677-02 7/01/2016 8/19/2016 EACH OCCURRENCE $ 4,000,000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4.000.000 I , DED X RETENTION$ 10-000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYY/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ I If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of Everett is named as additional insured under the General and Auto Liability CG2026 Endorsement attached CERTIFICATE HOLDER CANCELLATION City of Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore, Suite 7A Everett, WA 98201 AUTHORIZED REPRESENTATIVE ..__(. ©19� CCORPO RATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD