Robin Kirschbaum, Inc. (RKI) 11/21/2016

A Qlllt CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYV) 10/31/2016 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: Pearl Insurance PHONE FAX (A/C.No,Ext): (A/C,No): 1200 E Glen Ave E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Peoria Heights IL 61616 INSURER A: Travelers Indemnity Company 25658 INSURED INSURER B: Underwriters at Lloyd's of London AA-1122000 Robin Kirschbaum INSURER C: _ 425 30th Ave INSURER D: INSURER E: Seattle WA 98122-6232 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP w /YLIMITS LTR INSR VD POLICY NUMBER (MM/DDYYYI (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE [X]OCCUR � MED EXP(Any one person) $ 5,000 A Y Y 680-1G90921A 07/20/2016 07/20/2017 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY—II JECT IX LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO I BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED Y Y 680-1G90921A 07/20/2016 07/20/20171 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) i E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability ! $1,000,000 per claim/$1,000,000 aggregate B Retroactive Date:07/15/2015 N N 2200980-01 07/15/2016 07/15/2017 $5,000 deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Everett,its officers,employees and agents are afforded Additional Insured and waiver of subrogation coverage under General Liability Blanket Additional Insured Endorsement CG D3 81 09 15 and Xtend endorsement CG D3 79 01 16,Completed Operations endorsement CG D3 09 11 03 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett,its officers, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN employees and agents ACCORDANCE WITH THE POLICY PROVISIONS. 3200 Cedar Street AI i;RI7r, ENTATIVE Everett WA 98201 /yl�l J�'�6\rr/l//((// l/ ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD