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DATE <br /> ACC)R ® CERTIFICATE OF LIABILITY INSURANCE 6/8/2017/DDmYY) <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 /> CONT <br /> PRODUCER NAMEACT Melissa Canestro <br /> Hall&Company PHONE 360-626 2008 FAX 360-598-3703 <br /> 19660 10th Ave NE (A/C Nn,Fet) (A/C.Nor <br /> Poulsbo WA 98370 AIL <br /> ADDRESS:mcanestro@hallandcompany.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Sentinel Insurance Company 11000 <br /> INSURED 13274 INSURER B: <br /> Carla Nasr INSURER C: <br /> DBA:Traffic Data Gathering <br /> 11410-13th Street SE INSURER D: <br /> Lake Stevens WA 98258 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 1729768703 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 SUBR POLICY EFF POLICY EXP <br /> LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS <br /> A COMMERCIAL GENERAL LIABILITY 52SBMF09211 2/28/2017 2/28/2018 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED <br /> PREMISES(Eaoccurrence) $1,000,000 <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 /> PRO- <br /> POLICY X JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 <br /> OTHER: $ <br /> A AUTOMOBILE LIABILITY 52SBMF09211 2/28/2017 2/28/2018 COMBINED SINGLE LIMIT $ <br /> (Ea accident) 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOSNED SCHEDULED BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per accident) <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION 52SBMF09211 2/28/2017 2/28/2018 PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE X ER WA Stop Gap <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) <br /> The certificate holder is an additional insured per the attached. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Attn:Corey Hert,PE ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3101-Cedar Street <br /> Everett WA 98201 <br /> AUTHORIZED REPRESENTATIVE <br /> V 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 />