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;. ` , � I CHUBB/PACh . <br />100 William Street <br />-:-iugtz New York, N. Y. iG038 <br />� INDEMf�:IT•Y GROUP <br />3200 Wil;iiire Bou!ornrd <br />Los Anc�ele�, Cali(. g0010 <br />Nome and eddress of party to whom this eertlficato ia lssued <br />CITY OF EVCRECT �pEDERAIINSUflANCECO. <br />CITY HALL _p��iFic iNoeMNirv co. <br />�VERL•TT � �LISIIINGTOA _SUN INSURANCE OFFlCE LTD. <br />Cr�TIFIC' <br />s.��l:_Uf'�`�i � — <br />� <br />Certificate No. <br />_GREAT NORTHERN INSUFIANGE CO. <br />VIGILANT INSUflANCE CO. <br />Neme S Address Insured Nume 6 Address Produce r <br />JOHN SCHNEIDER GILhtiY-ARMSTRONG Ih75UttA�yCE, ItiC. <br />G529 LONfiARD P. 0. UOX 8�9 <br />CVERETT� IdASHI[:GTON 98203 EVEREPT� WASIII�GTUN 98206 <br />This is to certify that the Cempany indicated by X has issued ro tho Named Insured Insurence offording auch coverogee as s�e !n- <br />dicetad by o specific (X) entry In thu Coverage column suhJect to tho terma, conditlone, end excluslana of the pollcyiios) ond that <br />euch insurance is in torce os of (dote) .. <br />TYPE OF POLICY <br />Slmdard Workm�n9 Companeatlon <br />• Employ�n' Gablliry <br />Gc:+arel Liabllity—BOpILY INJURY <br />ndent <br />Specllled Contractusl' <br />Plonket Controclual <br />Genor�l Uabillty—PROPERN DAMAGE <br />Fscnlalorc _ <br />SpnCilicd ConfrBClual' <br />( Blanket Conlractual <br />Aulomohlle Llnbillty—BODILY INJURY <br />Owned Automotilos __ <br />Hired Aulomoblles _ <br />X <br />X <br />Au!omoUile LIebII11Y—P90PERTY DAMAGE I X <br />(76)7775 <br />35 19 <br />Efl. <br />Efl. L-12-75 <br />E%p. 1-12-76 <br />(76)7775 I <br />� En. 1-12-75 <br />35 19 II �yP 1-12-76 <br />LIMITS OF L�ABILITY <br />SUtulory—In confortnance wNh the <br />S <br />F100,000 <br />fNo�r coveacn <br />(SNOT COVERED <br />1 <br />5 25,000 <br />S 25,000 <br />y 25,000 <br />SnoT cov�aen <br />SNOT COVIi[tEU <br />y 50�000 <br />s100,000 <br />25,OOC <br />Each Fereon <br />Eech Qccurrenco <br />Aggregate-Producl <br />Compl. Opor. <br />Each Pereon <br />Each Ocwr;ence <br />Ench Occurrenco <br />qpq: Prna�. Opor. <br />Aggrepein•Prntuct <br />Ag�'o(lato-Produc <br />Compl. Oper. <br />Eech OccW'rance <br />,voaronaro <br />Each Po��on <br />Exch Ccr.urmnos <br />Exch Occurtnnce <br />Hlred Autemobiles .�_ <br />Nonowr.�d Au�omobllos � �-- � � <br />Coverege Is prov;deA ter Ilability essumed by lho 4amod Insurcd lor 1os provldedblo the'conl ec untl �Iatillta covsrngo pert attecheC tn the policy, <br />detc+d <br />FO[: llE110LSTI0h OP RU1i.DING AT 5217 E7. Z?�'D, 1:VERliT'P� F.'.'�S�IINGTO:: <br />THIS CERTIFlCATE OF INSUHANCE NEITHER AFFIRNATIVEL� NOR NEGATNELY P.MEIJUS, EXTFf�DS QR A�TEAS 1HE COVE'IAGE I <br />, AFFORDED BY ANY POLICV DESCRIBED HEREIN <br />111he pclicylles� is cancelled or changod in such manner as to allocl Ihis cehiliceto, tho Company will mell lo tho pnrry to whom this cer Ilicalo Is <br />Issuod, at iha uddtesa shown �bovc, 10 days noUco ol any such chenge oi e.ncollallon. /). � /,� n��u,iC <br />�� � _— <br />Tlds eodilicato shell nol ba valld unless signe+d by en authodzed rapresonteHve ol tho Company.__-- a�u�or�:oa Ncr�aecraauvo i <br />i:r , .. <br />Porm 21101 (Rev. 542) <br />