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ENG2022-0497+Certificate_of_Liability_Insurance+10.5.2022_1.02.55_PM+3147726D&AVO LT-01 J PABALATE , 111. 0 CERTIFICATE OF LIABILITY INSURANCE �� DAT0/5/2D/YYYY) 10/5/2022 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 have ADDITIONAL INSURED provisions or 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 License # OC36861 CONTACT NAME: PHONE FAX -9205 (A/C, No, Ext): (206) 204-9140 No):(206) 204 Seattle-Alliant Insurance Services, Inc. 1420 Fifth Ave 15th Floor Seattle, WA 98101 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Eagle West Insurance Company 12890 INSURED INSURER B : INSURER C : Voltsis Ventures LLC INSURER D : 18411 Aurora Ave N Shoreline, WA 98133 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM DD YYY POLICY EXP MM DD YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X 25BOP2070013718 12/31/2021 12/31/2022 DAMAGE TO RENTED PREMISES Ea occurrence 300,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYEl PECOT- �X LOC PRODUCTS - COMP/OP AGG $ 2,000,000 LIQUOR $ 1,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ ANY AUTO 25BAA270013719 12/31/2021 12/31/2022 OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE 25CUL2070013720 12/31/2021 12/31/2022 DED X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 25BOP2070013718 12/31/2021 12/31/2022 PER X OTH- STATUTE ER 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is understood and agreed that the City of Edmonds Is named as additional insured for a flower pots located at 320 5th Avenue S Edmonds in the City of right of way. 30 days notice of cancellation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Edmonds Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Divison 121 5th Avenue North AUTHORIZED REPRESENTATIVE Edmonds, WA 98020 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 25-BOP-2-070013718 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SECTION C — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) specified in a written contract or agreement that such person(s) or organization(s) are to be shown as an additional insured on your policy, but only with respect to liability for "Bodily Injury," "Property Damage," "Personal Injury" or "Advertising Injury" caused, in whole or in part, by: Your acts or omissions; or 2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations. Coverage Limitations and Exclusions: 1. The "Bodily Injury," "Property Damage," "Personal Injury" or "Advertising Injury" coverage applicable to the additional insured must be caused by an "occurrence" in the coverage territory during the policy period, and the initial "occurrence" takes place after you enter into the written contract or agreement. A person or organization's status as an Insured under this endorsement ends upon the earlier of, when your obligation under the written contract or agreement is completed, or upon the expiration of coverage under this policy. 2. The insurance provided to the additional insured under this endorsement does not apply to "Bodily Injury," "Property Damage," "Personal Injury" or "Advertising Injury" arising out of "Construction," "Subcontracting," "Developing," or "Real Estate" operations performed by or for, or at the direction of any Insured. For purpose of this exclusion, the following additional definitions apply: a. "Construction" includes but is not limited to any and all building, remodeling or renovating, designing or planning any of the above including but not limited to the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications. b. "Subcontracting" includes but is not limited to the act of entering into written or oral contracts or agreements with others for "construction" related operations. C. "Developing" includes but is not limited to the "construction," planning, designing, and/or development of land into residential or commercial buildings or structures. d. "Real Estate" includes but is not limited to any conduct relating to the purchase, sale, remodeling of, investment in, or breach of any written or oral contract, relating to any residential or commercial buildings or structures. This exclusion does not apply to an "insured contract" for a lease of premises. 3. "Bodily Injury," "Property Damage," "Personal Injury" or "Advertising Injury" arising out of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the additional insured would have in the absence of the contract or agreement. 03-022 (02-07) Page 1 of 1