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® DATE(MM/DDNYYY) <br /> A 3 L7 CERTIFICATE OF LIABILITY INSURANCE <br /> 05/14/2019 <br /> THIS CERTIFICATE IS ISSUED ASA 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 <br /> NAME: <br /> FAX <br /> Cindy Smith Insurance Agency Inc AHONNo,Ext): (A/C,No): <br /> 2707 Colby Ave Ste G ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Everett WA 98201 INSURER A: Mount Vernon Fire Insurance Co. 26522 <br /> INSURED INSURER B: <br /> Marl's Place INSURER C: <br /> 2321 Hoyt Avenue INSURER D: <br /> INSURER E: <br /> Everett WA 98201 INSURER 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 /> INSR ADULSUB i POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDNYYY) LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO CLAIMS-MADE n OCCUR PREMISES(Ea occuErrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> A _ Y NPP2559429E 04/14/2019 04/14/2020 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATELIMIT APPLIES PER. GENERAL AGGREGATE j 2,000,000 <br /> X POLICY n n LOC PRODUCTS-COMP/OPAGG $ Included <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> _ AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIR ED AUTOS _ AUTOS (Per accident) _ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTION$ $ <br /> WORKERS COMPENSATION PER 0TH- <br /> AND EMPLOYERS'LIABILITY Y/N I STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? ( N N/A <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 /> A Professional Liability $1,000,000/$2,000,000 <br /> NPP2559429E 04/142019 04/14/2020 <br /> Abuse and Molestation $100,000/$200,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> The City,its officers,employees and agents are named additional insured per form CG2026(04/13). <br /> ****10 Day Notice for Non-Payment of Premium**** <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 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 2930 Wetmore Avenue AUTHORIZED REPRESENTATIVE <br /> Suite A <br /> Everett WA 98201 (fP/1 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />