Jean Bergo 11/27/2018 - Laserfiche WebLink

ARE? DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/26/2018 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 have ADDITIONAL INSURED provisions or 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). CONTACT PRODUCER LibertyMutual Insurance NAME: PO Box 188065 PHONE FAX Fairfield OH 45018 No.Ext): E-MAIL800-962-7132 (A/C,No): 800-845-3666 E-M ADDRESS: BusinessServiceALibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Ohio Security Insurance Company 24082 INSURED INSURER B: Jean Bergo 9624 NE 182nd Court INSURERC: Unit A INSURERD: Bothell WA 98011 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 45082791 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. ILTR TYPE OF INSURANCE IANSD DDL SWVD POLICY NUMBER /YUBR POLICY EFF POLICY EXP LIMITS (MM/DDYYY) (MM/DD/YYYY) A �/ COMMERCIAL GENERAL LIABILITY / BKS54951601 11/1/2018 11/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE CLAIMS-MADE ,/ OCCUR PREM SESO(Ea occurrence ) $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY BKS54951601 11/1/2018 11/1/2019 �EOMaBclNdeot,INGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE - $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 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,agents and employee's are Additional Insured if required by written contract or written agreement subject to General Liability Blanket Additional Insured Provision. CERTIFICATE HOLDER CANCELLATION Cityof Everett SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Everett Senior Center ACCORDANCE WITH THE POLICY PROVISIONS. 3025 Lombard Everett WA 98201 AUTHORIZED REPRESENTATIVE La's'l Lon Giannini ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 45082791 1 54951601 1 18-19 Master Certificate 1 Lon Giannini 1 10/26/2018 9,25:42 AM (PDT) 1 Page 1 of 9