Robin Kirschbaum Inc. (RKI) 2/24/2017

DATE(MM/DDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 02/13/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Pearl Insurance PHONE FAX (A/C,No,Ext): _ (AIC No): 1200 E Glen Ave E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Peoria Heights IL 61616 INSURER A: Travelers Indemnity Company 25658 INSURED INSURER B: Underwriters at Lloyd's of London AA-1122000 Robin Kirschbaum INSURER C: 425 30th Ave INSURER D: INSURER E: Seattle WA 98122-6232 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY] GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 A Y Y 680-1 G90921 A 07/20/2016 07/20/2017 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED Y Y 680-1 G90921 A 07/20/2016 07/20/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS \/ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB ■ CLAIMS-MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability $1,000,000 per claim/$1,000,000 aggregate B Retroactive Date:07/15/2015 N N 2200980-01 07/15/2016 07/15/2017 $5,000 deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) When agreed in a contract or agreement,City of Everett,its officers,employees and agents are afforded Additional Insured and waiver of subrogation coverage under General Liability,Automotive,Additional Insured Endorsement CG D3 81 09 15 and Xtend endorsement CG D3 79 01 16,Completed Operations endorsement CG D3 09 11 03 and is primary and noncontributing. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Heather Griffin,PE ACCORDANCE WITH THE POLICY PROVISIONS. 3200 Cedar street Everett WA 98201 A�{THORID�jEP ENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD