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A R!TJ CERTIFICATE OF LIABILITY INSURANCE DATE <br /> (M1s "" <br /> D "` <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT David Williams <br /> NAME: <br /> Markel Service Incorporated (AJC.No,Ext): 678-290-3814 FAX <br /> fart Nu): <br /> 4600 Cox Road n DRESS: dawilliams@markelcorp.com <br /> Glen Allen,VA 23060 PRODUCER <br /> CUSTOMERID13257 <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Markel Insurance Company 38970 <br /> Vicki Venolia INSURER B <br /> 2313 113th Dr SE#A INSURER C: <br /> Lake Stevens,WA 98258 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 1139924 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 TYPE OF INSURANCE ADDL SUER POUCY EFF POLICY EXP LIMITS <br /> LTR INSR WVD POLICY NUMBER (MM/DDIYYYYI (MMIDDIYYYY) <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> AMAGE REN I hl./ <br /> COMMERCIAL GENERAL LIABILITY PREM SES(Ea occurrence) $1,000,000 <br /> CLAIMS-MADE • OCCUR FTG6562-02 7/3/18 7/3/19 MED EXP(Any one person) $5,000 <br /> A Professional Liability PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $3,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 <br /> POLICY n JECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED ❑SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED <br /> ni AUTOS PROPERTY DAMAGE <br /> (Per accident) <br /> $ <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE S <br /> --I <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> Certificate Holder is included as an Additional Insured per the Blanket Additional Insured Endorsement <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Everett,its officers,agents,and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> The Carl Gipson Senior Center of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> 3025 Lombard ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Everett,WA 98201 <br /> AUTHORIZED REPRESENTATIVE 0 , <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />