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® DATE(MM/DD/YYYY) <br /> ,A`c• O CERTIFICATE OF LIABILITY INSURANCE <br /> 11/28/2018 <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: Susan Davidson <br /> Calrose Insurance (A/cC.No.Extl: (425)525-5188 A/C, <br /> No): <br /> 2231 Broadway E-MAIL R <br /> D <br /> DSS: sue@epicinsure.net <br /> Everett, WA 98201 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA: Scottsdale Insurance Company <br /> INSURED INSURER B: <br /> Andy Boo INSURER C <br /> DBA:Andy Boos Outdoor Leader <br /> 2310 Rainier Ave INSURER D: <br /> Everett,WA 98201 INSURER E <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 /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER IMM/DD/YYYYI (MM/DD/YYYY) <br /> A X COMMERCIAL GENERAL LIABILITY Y CPS2928603 12/0512018 12/05/2019 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE RENTED <br /> CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY I JECOT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: .$ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED I 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 I RETENTION$ $ <br /> WORKERS COMPENSATION PER <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE <br /> ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <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 /> Certificate holder is listed as an additional insured but only as respects to operations of named insured <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> It's Officers, Employees &Agents ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2930 Wetmore Suite A <br /> Everett, WA 98201 AUTHORIZED REPRESENTATIVE <br /> ;�G �y <br /> L.�: Ck-c1 (SGD) <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 SGD on November 28,2018 at 10:24AM <br />