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DAHCORP-01 JCANO <br /> Aisms CERTIFICATE OF LIABILITY INSURANCE DAT/13/2D/YYYY) <br /> �--� 911312016 <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. PHONE 415 257-2100 FAX (415)455-1516 <br /> 1752 Lincoln Avenue (A/C,No,Ext):( ) (A/c,No): <br /> San Rafael,CA 94901 A <br /> ADDDREDRE <br /> SS: <br /> INSURER(S)AFFORDING COVERAGE NAIC/1 <br /> INSURER A:Valley Forge Insurance Company <br /> INSURED INSURER B:Continental Casualty Company <br /> DAH Corporation DBA ISOutsource INSURER C: <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 <br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR X 508807322809/19/2016 09/19/2017 DAMAGEIORENfED 300000 <br /> PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY JEo LOC PRODUCTS-COMP/OPAGG $ 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 AUTOS <br /> X X NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS (Per accident) <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 <br /> A EXCESS LIAB CLAIMS-MADE 5088073262 09/19/2016 09/19/2017 AGGREGATE $ 5,000,000 <br /> DED X RETENTION$ 10,000 $ <br /> WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE 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 /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Mountain Pacific Bank 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 /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Mountain Pacific Bank <br /> Mou Iain Broadway ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3732Everett,WA 98201 <br /> AUTHORIZED <br /> D REPRESENTATIVE <br /> V� <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />