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DATE(MM/DDIYYYY) <br /> ACCORD. CERTIFICATE OF LIABILITY INSURANCE <br /> t r..+-- 03/19/2019 <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(les)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 certif �7(}Ar o fleer/}{�' }ry eafeholder in lieu of such endorsement(s). <br /> lYiM J V ILLS MI J CONTACT <br /> PRO! pix,m_ Wendy Dahlquist <br /> N ,Il 360-653-0900 _ — EAX J . 360-659-8494 <br /> 13805 SMOKEY POINT BLVD. #105A tws: wendy(d�marysvilleandersonins.com <br /> WASHINGTON 98271 -. wsuRElusIAFFOROINccoNAIC# <br /> _ MARYSVILLE, INsuRERA: OHIO SECURITY INSURANCCEECOMPANY <br /> INSU _ INSURER B: <br /> UCE'B <br /> BRARSTOW Gig- <br /> -. » + INSURER C: <br /> DOG DAY AFTERNOON INSURERD: <br /> 1242 STSTE AVE STE 1 PMB 270 INSURERE: <br /> MARYSVILLE,WA 98270 mom F= <br /> COVERAGES CERTIFICATE NUMBER: 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 /> USSR AISDL St:TBR1 ..._. .._ _ POUCYEFF. FOUGYEXP._ <br /> LTR TYPE OF INSURANCE INSD WvD I POLICY NUMBER I(MMITSIMYY) (MAVDD/YYYY1 LIMITS <br /> COMMERCIAL GENERAL 1,000,000 <br /> X EACH OCCURRENCE $ <br /> X CLAIMS-MADE fl OCCUR DAMAOrt0RENTEL7 <br /> PREMISES(Ea ormg-Rwe). 8 1,000,000 <br /> _MED EXP(Any ono person) $ 15,000 <br /> A X BKS57915172 07/25/2018 07/25/2019 PERSONALBADVINJURY $ 1,000,000 <br /> GERI.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY dRCaT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> OTHER: J$ <br /> AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ <br /> 1E4 adddehl) <br /> ANY AUTO BODILY INJURY(Par person) 5 <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> • HIRED NON-OWNED pROYERIYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Peraccidentf <br /> $ <br /> UMBRELLA UAB OCCUR - EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> •WORKERS COMPENSATION PER M <br /> OT <br /> AND EMPLOYERS'LIABIUTY y-)N I STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUI1VE 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 I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> CERTIFICATE HOLDER IS LISTED ADDITIONAL INSURED <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> CITY OF EVERETT,ITS OFFICERS,AGENTS,EMPLOYEES ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 802 E.MUKILTEO BLVD 1 . i c <br /> AUTHO-i+ •REPRES ATIVE <br /> EVERETT,WA 98203 / 1 <br /> 1 1141 <br /> © . 8-2t ..CORD ©RPORATION. II rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered of A ORD <br />