Laserfiche WebLink
DATE(MMIDDIYYYY) <br /> Accmo CERTIFICATE OF LIABILITY INSURANCE 12/2�/2017 <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 the <br /> 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 STATE FARM INSURANCE NAME:CONTACT Caitlin Infausto <br /> 2328 PACIFIC AVE STE 100 IA/C.No.ExtI 503-992-6700 (a/c,No):503-992-6788 <br /> FOREST GROVE, OR 97116 ADDRESS:caitlin.infausto.e086(astatefarm.com <br /> AP INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:State Farm Fire and Casualty Company 25143 <br /> INSURED Christine Clark <br /> INSURER B <br /> 4020 NE Rosa Parks Way INSURER C: <br /> Portland, OR 97211 INSURER D: <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. NOTIMTHSTANDING 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 'ADDL SUBRT 1 POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSR WVD i POLICY NUMBER 1(MM/DD/YYYY) (MM/DD/YYYY) LIMITS <br /> A GENERAL LIABILITY !I j 97-BV-F665-9 12/20/2018 12/20/2019 EACH OCCURRENCE $ 1.000.000 <br /> '-- DAMAGE TO RENTED <br /> X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 300,000 <br /> I___!.CLAIMS-MADE X'!OCCUR MED EXP(Any one person) $ 5,000 <br /> I <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER' '. PRODUCTS-COMP/OP AGG $ <br /> X POLICY LOC Personal Liability $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) $ <br /> I1 ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED I SCHEDULED ! BODILY INJURY(Per accident) i <br /> $ <br /> AUTOS IAUTOS <br /> HIRED AUTOS I NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per accident) <br /> • J UMBRELLA LIAB I OCCUR - <br /> EACH OCCURRENCE $ <br /> EXCESS LIAB • I CLAIMS-MADE] AGGREGATE $ <br /> DED !; RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- I O <br /> 'AND EMPLOYERS'LIABILITY ,r I N TORY LIMITS! I ER _ <br /> OFFICE/MEMBER REXCLUDED EXECUTIVE N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) ! E.L.DISEASE-EA EMPLOYE: $ <br /> If yes,describe under i <br /> DESCRIPTION OF OPERATIONS below ! E.L.DISEASE-POLICY LIMIT I$ <br /> 1 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> The City of Everett,and its officers,employees and agents are added as Additional Insureds on policy. <br /> Creating a hanging public art project. <br /> CERTIFICATE HOLDER CANCELLATION <br /> ANY OFBE <br /> City Of Everett THE SHOULD <br /> XPIRATIIONHDATE E VTHER OF, NOTICE DESCRIBEDPOLIC1 WILL BE ES CDELIVERED BEFOREIN <br /> 2930 Wetmore Ave. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett,WA 98201 <br /> AUTHORED REPRESENTATIVE <br /> ©1988- 010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010 <br />