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Certificate of Insurance.pdf
CERTIFICATE OF LIABILITY,. EvidenceEvidencecc TEIMM D9/A7/2016 7 /2 ODDnYVY) 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 ISSUINGINSURER(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). PRODUCERCONTACT A T NAME ��l..�Gilbertson rBCIl (425)828-6822 Ext __._..._ (_4_2...5) 82<-03i212509 130th Lane NE #B132E-MAIL _ srJclana�, WA 80134 ADDRESS dale@ [5lal^ib. Com ._.... ..._. .._.... .._. ..w._ .,_.. _ ....__ INSURERS) A.F.FORDING COVERAGE I MAICt& MSURERA: Houston Specialty IIIc' CO INSURED ACH NW LLC;INSURER B 221 185th Place SWI I� NSURER tv Bothell, WA 98012 rNSURERD , -......_. - (206)' 423-2549 INSURER F: 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 TE',RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. _.., _ INSR _ 'AODL sDRR _.._ .._ _...., ... _.... POLICY EFS—P LIGC�7 K LTR. TYPE OF INSURANCE IN56 tirwn POLICY NUMBER MMlDDffYYY MM!DDNYYY LIMITS }' COMMERCIAL GENERAL LIABILITY _ICL EACH OCCURRENCE $ 1,000 (,�(,(,}'' "".._ I __.I OCCUR IuT.KCT.17�7-Tie R'E'NTEtF--�"_,__. PREMISES Ea occurrence _m ._..L ..._� $ 10CJ' 000 __. .. r ...., - i TE `17213 ! (53j10/20g6 03/1©/207.7 MED EXP (Any ,one person( $ 5,000 ._.— .. _.._.. PERSONAL &,ADV INJURY $ 1.,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: T GENERAL AGGREGATE $ 2,000,000 POLICY CD JFCT �I LOC PRODUCTS - COMPIOP AGG .. ......._...._.. ' $ 2,000,000 OTHER.-, P AUTG)MOSILE LIAB6LG"I"Y MBINED IN E LIMIT $ ANYAUTO ALL OWNED _ SCHEDULED BODILY INJURY (Per person) -.....- $ ...._. ODILYINJURY (Per accident) .._..._ m..... $ AUTOS AUTOS .._ NON -OWNED.... HIREDAUTOS _ AUTOS PR©PERTY�DAMAGE�.u- Per accident .._,_. ......, $ UMBRELLA LIAB OCCUR r EXCESS LIAB CLAWS-MADE EACH EACH OCCURRENCE $ $ DED RETENTION $ ' .AND WORKERS COMPENSATION EMPLOYERS LIABILITY Y/N PE TF STATUTE., ER ( ANY PROPRIETOR/PARTNER/EXECUTIVE OFHCER/MEMBER EXCLUDED' �,,N7A � ( E. L. EACHACCIDENT $ i IF enrin NH) If yes,, describe under E.I_. DISEASE - EA EMPLOYE DESCRIPTION OF OPERATIONS trePow ' E.L. MSEASE.. -POLICY LIMIT . $ I DESCRIPTION OF fIPPRATIMM I LOCATrcONIS! VEH!r•, r�.nnr,.r...�. „_..,..... .... .. 1, l rE jtl�...1 Irks auireauie, may ae attacned rY more space rs required) Evidence of Insurance .- rance CERTIFICA EdmondsCity of 121 5th Avenue NE 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 REPRESEOATIVE .. @ 1908-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD