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PROFESSIONAL LIABILITY <br /> ADDITIONAL INSURED Page 1 <br /> Agent Information Certificate#: 201706206 <br /> Vicencia&Buckley A Division of HUB International Member#: 169699 <br /> Insurance Services Effective Date: 07/1 4/201 6 <br /> 6 Centerpointe Drive,#350 <br /> La Palma,CA 90623-2538 Expiration Date:6/30/201 7 1 2:01:00 AM <br /> (714)739-3177 FAX (714)739-3188 90 DAY DISCOVERY PERIOD <br /> (800)223-9998 <br /> License#:151305 Policy issued by Lexington Insurance Company <br /> Insured's Name and Mailing Address Policy#:014266055 <br /> DONER,FERENC, E <br /> 919 OLYMPIC AVE <br /> EDMONDS,WA, 98020 <br /> Additional Insured(See Additional Insured-Blanket Form): <br /> MOSS BAY DIVE CLUB <br /> UNDERWATER SPORTS INC <br /> KING COUNTY PARKS(REDMOND FORWARD THRUST POOL) <br /> KING COUNTY PARKS(MERCER ISLAND POOL) <br /> STATE OF WASHINGTON (FIRCREST POOL) <br /> CITY OF EDMONDS(YOST POOL) <br /> SHORELINE POOL <br /> SEATTLE UNDERWATER SPORTS <br /> EDMONDS UNDERWATER SPORTS <br /> BELLEVUE UNDERWATER SPORTS <br /> CITY OF EVERETT <br /> LAKE FOREST PARK POOL <br /> EXOTIC AQUATICS <br /> Issued on behalf of: Authorized Representative <br /> Lexington Insurance Company <br /> Steve Vicencia CPCU <br />