20161007161543.pdfATE(M/DD/YYYY)
CERTh .SATE OF LIABILITY INSURA, ;E 19;m
7/2016
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 endorsam,ent(s).
PRODUCER Pd UNo (425) 8 8 682 2 f N ._.�._w 03 2
RHIS/BCIB Dale mm 425)822-037
12509 130th Lane NE #B132 Elµw
Kirkland, WA 98034 gat dale �Ohcilk�, comet..,, �mm.. ...... __
SAdtl1"LRI"�) AFFORDING COVERAGE NAICN
!NSURI R A HOust o
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INSURED Ad NW LLC
221 185th Place SW ,INSURERC :
Bothell, WA 98012 INSURERD
(206) 423-2549 INSURER E
COVERAGES CERTIFICATE NUivNBER, REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISIED 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,
D CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
EXCLUSIONS AN N
LAR TYPE �.. N t Nmo wv�r POLICY NU14tl ..� .m. �.,.�.................
PE OF INSURANCE +ESL�'�L.—., ... `i�I�`'d�".-.�...,IId�G� ,,..
— NUMBER M RON MMP175"fY Y LIMITS
COMMERCIAL GENERAL (ABILITY EACH OCCURRENCE I s 1 OOO OOO
DAMAGE'TO RMEU- ""° f„ .......
x � CLAIMS -MADE � X � occuR � PREdw1B5ES E $ 100 000
A
GEN'L AGGREGATE LIMIT APPLIES PER:
X R:'OII.VCYD I.IuE T J Loc
AUTOMOBILE LIABILITY
ANYAUTO
ALL OWNED` SCHEDULED
AUTOS �,� AUTOS
HIRED AUTOS NON -OWNED
AUTOS
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UMBRELLA LI LIAB J1__J
OCCUR
EXCESS AB CLAIMS -MADE
DEI) RETENTIONS
WO1 NSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNER/FXECUTIVE
OFFICER/MEMBER EXCLUDED? F NIA
(Mandatory in NN)
II+� e 6 sCa' be under
OI SCRIP110N OF OPERATIONS below
waccMumavj _......I_. .. et .............._
MED EXP (Awry one psaron) '$ 5, 0 0 0
10/2016 03/10,f2017
PERSONAL B ADV INJURY $. 1,000,000 �__
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMPIOP AGG $ 2 a 0OO , 000
$
BODILY INJURY Per arson
BODILY INJURY Per accident) $
(
,((rr de.ldrml.._..„„„..,...... $.
EACH OCCURRENCE
$
AGGREGATE
$
E L EACH ACCIDENT s
E L DISEASE - EA EMPLOYE $
E.L. I.NSEASE -POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Evidence of Insurance
City of Edmonds
121 5th Avenue NE
Edmonds WA 98020
ON
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 REPRESENTATIVE
01988-2201 ACORD CORPORATION. All rights reserved,
ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD