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.,_,---.•N DAHCORP-01 JCANO
<br /> ACRO DATE(MM/DD/YYYY)
<br /> ,._ CERTIFICATE OF LIABILITY INSURANCE 9/13/2016
<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
<br /> NAME:
<br /> Costello&Sons Insurance Brokers,Inc. PHONE415 FAX
<br /> 1752 Lincoln Avenue (A/C,No,Ext):( )257-2100 (A/C,No):(415)455-1516
<br /> San Rafael,CA 94901 ADDARESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURERA:Valley Forge Insurance Company
<br /> INSURED INSURER B:Continental Casualty Company
<br /> DAH Corporation DBA ISOutsource INSURER C:Lloyd's of London
<br /> 19119 North Creek Parkway#200 INSURER D:
<br /> Bothell,WA 98011
<br /> INSURER E
<br /> INSURER 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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WV /Y
<br /> D POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY)
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR X 5088073228 09/19/2016 09/19/2017 PREM
<br /> PREAMAGE MISES occurrence) $ 300,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER. STOP GAP LIAB. $ 1,000,000
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> A ANY AUTO 5088073228 09/19/2016 09/19/2017 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS
<br /> X HIRED X NNON-OWNED PROPERTYt)DAMAGE —(Per $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
<br /> A EXCESS LIAB CLAIMS-MADE X 5088073262 09/19/2016 09/19/2017 AGGREGATE $ 5,000,000
<br /> DED X RETENTION$ 10,000 $
<br /> WORKERS COMPENSATION X
<br /> AND EMPLOYERS'LIABILITY STATUTE OTH-
<br /> ER
<br /> Y/N
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE 5088073312 09/19/2016 09/19/2017 E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> C Tech E&O/Cyber ESF05210233 09/19/2016 09/19/2017 Each Wrongful Act 3,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Lakeside-Milam Recovery Centers is included as additional insured as required by written contract.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Lakeside Recovery Centers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ry ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Amy Luehrs
<br /> 10322 NE 132nd Street
<br /> Kirkland,WA 98034 AUTHORIZED REPRESENTATIVE
<br /> I
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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