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ACG ® DATE(MM/DD/YYYY) <br /> • <br /> CERTIFICATE OF LIABILITY INSURANCE 06i06/2017 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: Shelley Smith <br /> Epic Insurance,Petershagen Insurance, Insurance Center <br /> PHONE <br /> No.Ext): 425-252-5188 FAX No):425-339-9332 <br /> 2231 Broadway ADDRESS: Y@p Ave E-MAIL shelle a icinsure.net <br /> Everett,WA 98201 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Mount Vernon Fire Insurance Company <br /> INSURED INSURER B: <br /> Mari's Place INSURER C: <br /> 2321 Hoyt Ave INSURER D: <br /> Everett,WA 98201 INSURERE: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 1 <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 /> IPOLICY EFF POLICY EXPNSR R TYPE OF INSURANCE ADDL SUBR IMM/DD/YYYY) (MM/DD/YYYY) <br /> LTR INSD WVD POLICY NUMBER LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y NPP2559429C 04/14/2017 04/14/2018 EACH OCCURRENCE I$ 1,000,000 <br /> DAMAGE TO CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PES LOC PRODUCTS-COMP/OPAGG $ Included _ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS ONLY AUTOS ( ) <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> The below listed Certificate Holder is named as Additional Insured per attached policy endorsement. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2930 Wetmore Avenue, Suite A <br /> Everett,WA 98201 AUTHORIZED REPRESENTATIVE <br /> elA.A.0144.1 <br /> (SAS) <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> Printed by SAS on June 06,2017 at 12:48PM <br />