Third Hand Cloud Tai Chi Company 11/27/2018

ACoRL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `I.-- 10/1/2018 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 CL Central NAME: Leavitt Group NorthwestPH/ONNo Ext): (800)726-8771__._ AIC,No): (866)728-9168 PO Box 65770 E-MAIL Broker ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# University Place WA 98464 wswiERA:Scottsdale Insurance Company 41297 INSURED INSURER B: Third Hand Cloud Tai Chi Co INSURER C: 417 Tamarack INSURER D: Bill Broomall INSURER E: Everett WA 98203 INSURER F: COVERAGES CERTIFICATE NUMBER:18/19 Master 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' ADDLISUBRj _POLICY EFF POLICY EXP LIMITS -- _ --_--_ - LTR I TYPE OF INSURANCE INSD WVD I POLICY NUMBER I IMM/DD/YYYY) IMM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED _ -- A CLAIMS-MADE ' XI OCCUR , !! PREMISES(Ea occurrence) 100,000 X I CPS3052903 ! 5/9/2018 5/9/2019 MED EXP(Any one person) ..$ 5,000 !, PERSONAL&ADV INJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: !, GENERAL AGGREGATE $ 2,000,000 ' I PRO- ' 2,000,000 X ! POLICY , JECT L-_ LOC '., !, PRODUCTS-COMP/OP AGG $ OTHER. SII i ' Errors&Omissions-per claim $ 1,000,000 AUTOMOBILE LIABILITY , COMBINED SINGLE LIMIT I $ ! (Ea accident) l! -ll ANY AUTO BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED BODILY INJURY(Per accident) $ HIREDSAUTOS _�NOON-OWNED I — -- - - AUTOS I I �, , PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAB ---- — --- _ EXCESS LIAB OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE I $ I DED i WORKERS COMPENSATION I N$ $ , ! I --- PER 1 OTH- AND EMPLOYERS'LIABILITY YIN , STATUTE 1 ER __ I ANY PROPRIETOR/PARTNER/EXECUTIVE _i N/A E.L.EACH ACCIDENT I $ - OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ I If yes,describe under DESCRIPTION OF OPERATIONS below ,E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City of Everett, its officers, employees and agents are named additional insured with respect to General Liability per written contract with the named insured per form CG2026 04.13 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Its Officers, Employees and Agents ACCORDANCE WITH THE POLICY PROVISIONS. 802 E Mukilteo Blvd Everett, WA 98203 AUTHORIZED REPRESENTATIVE PJ zcGilmer/PJGILM --_X ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)