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® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 01/13/2018 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: American Family Insurance-Business Insurance FAX American Family Insurance-Business Insurance (A/c,NNo,Ext): 866-908-0626 (AOC,No): PO Box 5316 E-MAIL Binghamton,NY 13902 ADDRESS: service@amfambusinessinsurance.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: Midvale Indemnity Company 27138 INSURED INSURER B: TUANH NHAT NGUYEN INSURER C: 6121 176TH ST SW#E STE E INSURER D: LYNNWOOD WA 98037 INSURER E INSURER F1 COVERAGES CERTIFICATE NUMBER:054918100278620112 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR !NSR VJVD (MM/DD/YYYYUMM/DD/YYYY) GENERALLIABILITY EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY Y N BPP1014093 09/07/2017 09/07/2018 PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4,000,000 71 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT _(Ea accident) - ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS (Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE$ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER _ ANY PROPRIETOR/PARTNER EXECU -TIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT (Mandatory in NH) E.L DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A PROFESSIONAL LIABILITY Y N BPP1014093 09/07/2017 09/07/2018 OCCURRENCE $2,000,000 AGGREGATE $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Nail Salons City of Everett,WA and its officers,employees and agents"as additional insureds. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED CITY OF EVERETT BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2930 WETMORE AVENUE AUTHORIZED REPRESENTATIVE EVERETT WA 98201 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD BID 013 20130603 Page 1 of 1