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Certificate of Liability Insurance.pdfTHEWI-1 OP ID: HE01 CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYY) � 04/14114 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(les) 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). PRODUCER 425-489-4500 Hub International NW1Meier PO BOX 3018 425-489-4501 Bothell, WA 98041-3018 Michelle Hedin CONTACT NAME: AIG NNo Ext : NC No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE MAIC # INSURER A ; Continental Casualty Co 20443 INSURED The Wishing Stone Janet Yoshikawa 523 Main Street Edmonds, WA 98020 INSURER B: INSURER C; INSURER 1); INSURER E; 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. INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MMIDDNYYY OLICY EFF MMIDDIYYVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 4,000,000 A X COMMERCIAL GENERAL LIABILITY 5094590203 09/18113 09118/14 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 CLAIMS -MADE ® OCCUR MEI] EXP (Any one person) $ 10,000 PERSONAL & AOV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGO $ 2,000,000 POLICY JECT LOC $. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Per person) $ A ANY AUTO 5094590203 09/18/13 09/18/14 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY {Per accident} $ _ PROPERTY DAMAGE $ Per accident X HIREDAUTOS X NON -OWNED AUTOS X UMBRELLA LIAB - X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE 5094595935 09118113 09118/14 DED I X I RETENTION $ 10000 $ A 1NORKERSCOMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVEYIN 5094590203 09/18/13 09/18/14 XI WCSTATU- OTH- ORYLIMETS,_, T_" _ -ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA STOP GAP -------— E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT I S 2,000,000 A Property 5094590203 09/18113 09118/14 BPP 30,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 107, 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 sign/street use permit #20140228 located at 523 Main Street, Edmonds, WA 9B020 in the City right-of-way. Coverage is primary and non-contributory, CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) ©1988-2010 AGORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Edmonds THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Division 121 Sth Ave N Edmonds, WA 98020 AUTHORIZED REPRESENTATIVE r ACORD 25 (2010105) ©1988-2010 AGORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Interna Inal 12100 NE 195th Street, Suite 200 Y.O. Box 3018 Bothell, WA 98041-3 01 0 Office 4251489-4500 Fax 4251485-8489 HUB International Northwest, LLC Surety Bonds. Insurance Whv We Are Usina the Latest ACRD 24 & 25 Certificate of Insurance In September 2009, ACORD revised the ACORD 24 and 25 Certificate of Insurance form. One of the major changes was the removal of the cancellation notice provision. For the following reasons, we are unable to issue an older edition of this form, modify the current form, or complete a proprietary form you provide. Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this certificate is able to provide the cancellation notice you desire by endorsement. For example, the insured can cancel immediately, so it would be impossible for the insurer to give you the notice you request. State law also grants the insurer the right to cancel for reasons such as nonpayment with less notice than you require, For the reason just cited, if our agency was to issue a certificate that provides the cancellation notice you request, we would do so with the full knowledge that it would be irnpossible to actually give that amount of notice under certain circumstances. As such, the certificate could be alleged to constitute a misrepresentation or fraud which could subject our agency and staff to serious civil and criminal penalties. if a certificate purports to provide a policy right different from that provided by the policy itself, then the certificate effectively purports to be a policy form, Policy forms must be filed and approved by our state department of insurance. Use of nonfiled policy forms is illegal and could result in legal sanctions distinct from the assertion that the certificate is fraudulent. Under the ACORD Corporation's licensing agreement, the prior editions of superseded forms can be used for one year fi•om the time the new forms are introduced. Beginning in September 2010, this is another reason we cannot use an older edition of the ACORD 24 or 25. Doing so would violate ACORD's licensing agreement and, as a copyrighted document, federal copyright law. Likewise, we are unable to modify the new certificate to add a notice of cancellation. ACORD forms are designed to be completed, not altered. ACORD's Forms Instruction Guide says that a certificate should not be use "To waive rights... To quote wording from a contract... To quote any wording which amends a policy unless the policy itself has-been amended." In addition, our insurance company contracts only allow Lis to issue unaltered ACORD forms. We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our insurance company contracts only allow us to issue unaltered ACORD forms. Many proprietary certificates include broad, vague or ambiguous language that may or may not be incompliance with state laws, regulations, and insurance department directives. Therefore, we cannot issue any proprietary certificates that have not been reviewed by our state insurance department. You may be interested in how the City of Atlanta, Georgia is now reportedly dealing with this issue based on a very detailed study they conducted in 2008. They decided to no longer require direct notice of cancellation; accordingly, no conforming certificate or endorsement required. They also require contractors to fax a copy of insurer's cancellation notice within 2 business days of receipt. For their complete analysis: http://tbiyurl.cop /26guax8. We appreciate your understanding of the legal restrictions on our ability to fully comply with your request. This document was produced by the Independent Insurance Agents & Brokers of America (2010).