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Cert of Ins.Reliable Floors.Exp 6.28.17.pdf CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/22/2016 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 policy(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 endorsement(s). CONTACT Ginger Carlson PRODUCER NAME: FAX Degginger McIntosh and Associates PHONE (425)740-5200 (425)740-5201 (A/C, No): (A/C, No, Ext): E-MAIL 3977 Harbour Pointe Blvd SW ginger@DMAinsurance.com ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# MukilteoWA98275 American Economy Insurance Co. L19690 INSURER A : American States Insurance Co. INSURED INSURER B : Reliable Floor Coverings, Inc. INSURER C : 542 Main Street INSURER D : INSURER E : EdmondsWA98020-3148 INSURER F : 16/17 GL BA SG UMB COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSRWVD 6/28/20166/28/2017 A 2,000,000 GENERAL LIABILITY 02BZ20084210 EACHOCCURRENCE$ DAMAGE TO RENTED X 2,000,000 COMMERCIAL GENERAL LIABILITY$ PREMISES(Eaoccurrence) X 10,000 X CLAIMS-MADEOCCURMEDEXP(Anyoneperson)$ 2,000,000 PERSONAL&ADVINJURY$ 4,000,000 GENERAL AGGREGATE$ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- X $ POLICYLOC JECT COMBINED SINGLE LIMIT 02CE2323242 6/28/20166/28/2017 A AUTOMOBILE LIABILITY 1,000,000 (Eaaccident)$ X BODILYINJURY(Perperson)$ ANY AUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ BXX 6/28/20166/28/2017 1,000,000 01SU41407570 UMBRELLA LIAB EACHOCCURRENCE$ OCCUR 1,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X 10,000 $ DEDRETENTION$ A XXXXXXXXXXXXXXXX WC STATU-OTH- 6/28/20166/28/2017 WORKERS COMPENSATION X 02BZ20084210 TORY LIMITSER XXX AND EMPLOYERS' LIABILITY Y / N WA STOP GAP 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Right of Way; three signs attached to awning located over the public right of way; Permit #ENG20160480 City of Edmonds is included as Additional Insured per attached form BP7032(0702) with respect to any and all operations of the Named Insured. All endorsements apply per required Written Contract. CERTIFICATE HOLDERCANCELLATION Joanne.Zulauf@edmondswa.go (425)771-0221 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Edmonds Engineering Division AUTHORIZED REPRESENTATIVE 121 - 5th Ave. N Edmunds, WA 98020 Ken McIntosh/OGDON ACORD25(2010/05)©1988-2010ACORDCORPORATION.Allrightsreserved. INS025 TheACORDnameandlogoareregisteredmarksofACORD (201005).01