|
A ICIOR®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)09128/2017
<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 /> EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> t 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 Demi Dennis
<br /> NAME:
<br /> TRC Insurance PHONE (877)637-1858 FAX ( )425 818-2950
<br /> (AIC-No,Ext): (AIC,No):
<br /> 12015 115th Ave NE EMAIL cami@trcisu.com
<br /> ADDRESS:
<br /> Suite 240
<br /> INSURER(S)AFFORDING COVERAGE NAIL A
<br /> Kirkland WA 98034 INSURER A: American Alternative Insurance Corp
<br /> INSURED INSURER B:
<br /> Hand In Hand
<br /> INSURER C:
<br /> 14 E Casino Rd Ste E. INSURER 0:
<br /> INSURER E
<br /> Everett WA 98208 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 17/18 GL/ELIPIAbuse 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 ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD PIVD POLICY NUMBER (MMIDDIYYI'Y) IMMIDDIYYYY) LIMITS
<br /> X COMMERCIAL GENERAL UABIUTY 1,000,000
<br /> EACH OCCURRENCE 5
<br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED 5 1,000,000
<br /> PREMISES(Ea occurrence)
<br /> MED EXP(An one person) 5 15,000
<br /> A Y 99A2CP0003717-01 10/0112017 10/01/2018 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000
<br /> X POLICY PRO3,000,000
<br /> /ECT LOC PRODUCTS-COMP/OP AGG 5
<br /> OTHER: 5
<br /> I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s
<br /> (Ea accident)
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> IIIOUTOSWNEDONLY III AUSCTOSHEDULED BODILY INJURY(Per accident) S
<br /> A
<br /> ■ AUTOS ONLY IIIAUTOS ONLY (Per ac dentHIRED NON-OWNEPROPERTY)
<br /> DAMAGE $
<br /> IIII I 5
<br /> UMBRELLA UABIII OCCUR EACH OCCURRENCE
<br /> I
<br /> EXCESS UAB CLAIMS-MADE AGGREGATE
<br /> r
<br /> DED 1111 RETENTION S
<br /> 11.
<br /> WORKERS COMPENSATION I - O H-
<br /> AND EMPLOYERS'LIABiLI iY Y/di
<br /> ANY PROPRWETOR/PARTNER/EXECUTIVE 1,000,000
<br /> OFFICER/MEMBER EXCLUDED' CP Et EACH ACCIDENT 5
<br /> A � N 1 a 99A2,,,0003717-01 10/01/2017 10/Di 12013 �
<br /> (Mandatory in N)-)) { 1,0.0,000
<br /> If yes describe under E.L.DISEASE-EA EMPLOYEE S
<br /> I DESCRIPTION OF OPERATIONS below i POLICY11,000,000
<br /> E.L.DISEASE- LIMIT S
<br /> 1 PROFESSIONAL LIABILITY PER INCIDENT $1,000,000
<br /> A i ABUSE&MOLESTATION 99A2r1_001;15a-01 10,10112017 10/01'2013 A:OGRE,;ATE 53,000,300
<br /> 1 { DEDUCTIBLE £1,000
<br /> CESCRIP TION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101„Additional Remarks Se^eduie,mcy be eZ ached if more space is;-aqui:ad)
<br /> Cit;/of Evers(t,Its officers,emplcees and agents are additional insured
<br /> 1
<br /> r`_p Irl 11 7t.:., Cy', 71
<br /> A . .,0,73-^-„13,7 �'.7.C.Al- -;-,.. ,c 1
<br /> 7--,,- ,7,.7)
<br /> - - ,%'. .. )�_.,, -,-.7:::71:,.,:,):
<br /> ,
<br /> -,, r-F.,
<br />
|