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A4±® DATE(MMIDDIYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 3/23/2016
<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(ies) 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 CONTACT Zoe Anderson
<br /> NAME:
<br /> Thomas & Associates Insurance Broker, Inc.
<br /> PHONE
<br /> NO.EXt). (360)629-2103 (A/C,No):
<br /> (360)629-9702
<br /> 9715 271st St. NW E-MAIL
<br /> ADDRESS:zoe@thomasins.com
<br /> PO Box 457 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Stanwood WA 98292 INsuRERA:Philadelphia Indemnity Insurance 18058
<br /> INSURED INSURER B:
<br /> Cocoon House INSURER C:
<br /> 2 92 9 Pine St INSURER D:
<br /> INSURER E:
<br /> Everett WA 98201 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:CL1632302640 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD, POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYYI
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED 100,000
<br /> A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) , $
<br /> X PHPK1472114 4/1/2016 4/1/2017 MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X POLICY PRO-
<br /> JECT LOC PRODUCTS-COMP/OPAGG $ 3,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED X SCHEDULED PHPK1472114 4/1/2016 4/1/2017 BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE
<br /> X HIRED AUTOS X AUTOS (Per accident)
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000
<br /> A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000
<br /> DED X RETENTIONS 10,000 PHUB534811 4/1/2016 4/1/2017 $
<br /> WORKERS COMPENSATION PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE X ER
<br /> YIN
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> A (Mandatory in NH) PHPK1472114 4/1/2016 4/1/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below Stop Gap E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> A Directors and Officers PHSD1130999 4/1/2016 4/1/2017 Liability,Each Policy Period $2,000,000
<br /> Aggregate,Each Policy Period $2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> City of Everett, its officers, employees, and agents are additional insureds per the CG 20 26 04 13
<br /> endorsement.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 2930 Wetmore Ave Ste 1OA ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Everett, WA 98201-4067
<br /> AUTHORIZED REPRESENTATIVE
<br /> Scott Thomas/ZOE
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br /> INS025 r?n14o11
<br />
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