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EDMON-499999.pdf EDMON-4OP ID: CS CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/01/14 THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe certificate holder in lieu of such endorsement(s). CONTACT 206-285-7735 PRODUCER NAME: Lovsted-Worthington LLC FAX PHONE 206-285-3461 P.O. Box 607 Bothell WA 98041 (A/C, No): (A/C, No, Ext): 424 Third Ave W E-MAIL ADDRESS: Seattle, WA 98119 Dean R. Young INSURER(S) AFFORDING COVERAGENAIC # Colony Insurance Company INSURER A : Edmonds 2020, LLC INSURED INSURER B : 307 Bell Street INSURER C : Edmonds, WA 98020 INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSRWVD 5,000,000 GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED AXX 103GL00046370006/12/1406/12/16 100,000 COMMERCIAL GENERAL LIABILITY$ PREMISES (Ea occurrence) X 5,000 CLAIMS-MADEOCCURMED EXP (Any one person)$ 5,000,000 PERSONAL & ADV INJURY$ X stop gap5,000,000 GENERAL AGGREGATE$ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- Emp Ben.1,000,000 $ POLICYLOC JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident)$ BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Per accident) AUTOS $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ WC STATU-OTH- WORKERS COMPENSATION TORY LIMITSER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 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) E-26 Encroachment Permit #ENG20140287(for architectural features) and ENG20140300 (for shoring) Encroachment Address: 130 2nd Ave N ** Its is understood and agreed that the City of Edmonds is an additoinal insured per CG20120509 attached. CERTIFICATE HOLDERCANCELLATION EDMOND2 SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN City of Edmonds ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Division 121 5th Avenue North AUTHORIZED REPRESENTATIVE Edmonds, WA 98020 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD