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20140509143905080.pdf. Iita� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) Q5/02/2014 11 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 poiicy(ies) must 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 endorsements PRODUCER Scott M. Campbell Insurance Services Group, Inc. 600 Main Street, Suite A Edmonds, WA 98020 CONTACT NAME,. sCOttle mOfiett PHONE FAX AJC, No, E,,t426-775-6'44'6 [Arc, No]; 4_25-640-9225 EMAIL ADDRESS: SID ottiem insuranceservicesc roup.com _ INSURER(S) AFFORDING COVERAGE MAIC N Edmonds Insurance _ INSURER A: Ohio Security Insurance Co. 24082 INSURED e San r LLC g- 960 Edmonds Street Edmonds, WA 98020 1NSURERB: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR INsulleR c : ... ... .-- -- 01/0312015 INSURER D : MED EXP (Any one parson) 16,00 INSURER E X Business Owners INSURER F: COVERAGES CERTIFICATE NUMBER: 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. _ _NSR LTR TYPE OF INSURANCE AOUL SUB POLICY NUMBER MM DDIYYYY MMIDDPOLIcYeFF YIYYYY _ LIMITS W GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR BZS55917324 01/05/2014 01/0312015 _ PREM SE5AmAGF O a)aiTur ante $ 2,000,00 MED EXP (Any one parson) 16,00 _$ PERSONAL a AOV INJURY $ 2,000,00 X Business Owners _ GENERAL AGGREGATE $ 4,000,00 GENT AGGREGATE LIMIT APPLIES PER- PRODUCTS - COMPIOP AGG $ 4,000,00 PRO- POLICY1-1 LOC _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accldenl BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS LX PROPERTY DAMAGE $ PER ACCIDENT $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ l EXCESS LIAB CLAIMS -MADE DED I I RETENTION $_ $ WORKERS COMPENSATION. WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE TORY LIMITS _- E.L. EACHAC $ OFFICERJMEMBER EXCLUDED? ❑ NIA . "qCIDENT - E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NHl If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ PROPERTY 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 161, Additional Remarks Schedule, if more space is required) It is understood and agreed that: the City of Edmonds is named as an additional insured for the 3 signs for Sanger LLC dba Ombu located at 550 Main Street, Edmonds, WA 98020 - in the City right of way. CITYOFE City of Edmonds Engineering Division 121 5th Ave. N. Edmonds, WA 98020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. — _ AUTHORIZED REPRESENTATIVE ©19882010 ACORD CORPORATld /,Mtn s ACORD 25 (2010105) The ACORD name and logo are registered Enarks of ACORD OMBUS-2 PAGE 2 NOTEPAD INSURED'$ NAME Sanger LLC OP ID: SM Date 0510212014 Includes BP7996 0713 Businssowners Liability End1t. "VE IE I 2,19 1 k