410 WALNUT ST-Cert of ins (2).pdf3/6D61N
� W � ��,1 �, D DA.I E (MDti1Dlll5'YYY)
Ate"CERTIFICATE OF LIABILITY INSURANCE
2017
.....e. � ...... ..... UPON THE CERTIFICATE HOLDER.
INFORMATION ONLY AND CO
THIS CERTIFICATEIS ISSUED AS A MATTER OF I CONFERS NO RIGHTS .... 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
ificate holder 'is an ADDITIONAL INSURED, the po P _
PRODsub ec to the terms and conditionss of the policy, certain policies may require an
REPRESENTATIVE
_.
IMPORTANT If the cert y( ) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, f ( y 9
holder m lieu o rwdor�ew�ewwt endorsement A statement on is
certificate does not confer right to the certificatef such e
INSURANCE SERVICES GROUP INC/PHS
811422 P:(866) 467-8730 F:(888)
PO BOX 33015
SAN ANTONIO TX 78265
INSURED .�... ,.
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� c No emu- (866) 467-8730
443-6112 '
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Daess
WALNUT ST COFFEE LLC MAR 13 2017
19304 21ST AVE NW
.gRnRFT.TNF WA 98177
CERTIFI(:AIt HULUtK
City of Edmonds
Engineering Division
121 5TH AVE N
EDMONDS, WA 98020
No)- (888) 443-6112
NAIG9
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS
B�1g201�AO.�. _
.........-- . __- ..,..... D CORP ORAT ION, All rights reserve
The ACORD name and logo are registered marks of ACORD
ACORD 25 (2016103)