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ACERTIFICATE OF LIABILITY INSURANCE1 8/2016 ► <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 poilcy(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 <br /> Graber Insurance Services PHONEPHFAX <br /> 5704 Evergreen Way Suite CA'"`a Est)' 'Nol:MAII <br /> Everett,WA 98203 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIL S <br /> INSURERA Scottsdale Insurance Company <br /> INSURED INSURER B: <br /> Carolyn Henri <br /> DBA New Leaf Recreation " O.D' <br /> 4805 Belvedere INSURER D: <br /> Everett,WA 98203 INSURER E <br /> USURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 /> ADDLSUBA POLICY EFF POUCY EXP O <br /> LTR TYPE OF INSURANCE else wvo POUCY NUMBER .1MWDD(YYYYI (WIVPD(YYYYI <br /> GENERAL LUBSJTY X CPS-2343752 1/28/2016 1/28/2017 EACH OCCURRENCE 1,000,000.00 <br /> RENTED <br /> -X- COMMERCIAL GENERAL UAB1LrTY PREMISES(Ea occurrence) S 100,000.00 <br /> A CLAIMS-MADE X OCCUR IMED EXP(My one person) $ 5,000.00 <br /> PERSONAL&ADV INJURY $ 1,000,000.00 <br /> GENERAL AGGREGATE S 2,000,000.00 <br /> Copy <br /> GENT AGGREGATE LIMIT APPLIES PER: PRoDucis-COMP/OP AGO $ 2,000,000.00 <br /> POLICY I SCOT- LOC $ <br /> AUTOMOBILE LIABILITY COMBINEDMe tSINGLE LIMIT $ <br /> ANY AUTO <br /> BODILY INJURY(Per person) $ <br /> ALL OWNED � SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS (Per accident) <br /> S <br /> UMBRELLA LIAR OCCUR , EACH OCCURRENCE S <br /> EXCESS LUB CLAIMS-MADE AGGREGATE S <br /> DED I RETENTIONS $ <br /> WORKERS COMPENSATION WC STATU- 0TH- <br /> AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N(A E.L.EACH ACCIDENT S <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ <br /> t(yyeeaaCRIPTIdescrON ibe undOF OPERATIONS below E.L.DISEASE-POLICY UMIT S <br /> DES <br /> I i <br /> l i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddttIonal Ramarka Schedule,II mon apace Is required) <br /> Certificate holder is listed as art additional insured. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Everett <br /> IPS Officers, Employees and A ants SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 2930 Wetmore, Suite A ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett,WA.98201 <br /> AUTHORIZED REPRESEI(rATNE <br /> ©19884010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010(05) The ACORD name and logo are registered marks of ACORD <br />