Laserfiche WebLink
RTOWCOM-01 BROBERTS <br />ACQ►zn CERTIFICATE OF LIABILITY INSURANCE 79/2812016 <br />E(MMIDD/YYYY) <br />�� <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER ^CONTACT <br />NAME. Brian Roberts <br />Blue Lion Brokers PHONE 425 968-2236 FAX Hu $18 827-3380 <br />4208 198th St. SW Suite 206 Nn. Ext): ( ) {.+ic, ••..):_ ( ...... ) <br />Lynnwood, WA 98036 AIL s,,,: brian@bluelionbrokers.com <br />INSURERS] AFFORDING COVERAGE NAIC# <br />INSURER A: Sentinel Insurance Co LTD 11000 <br />INSURED INSURER B: ' <br />RTown Community <br />PO BOX 197 <br />Roslyn, WA 98941 <br />COVERAGES <br />CERTIFICATE NUMBER: <br />INSURER C. <br />INSURER D., <br />INSURER E! <br />INSURER F <br />REVISION NUMBER: <br />..—. ..... ... <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE fADD Lr8UBR POLICY NUMBER POLICY EFF . YOE.ICY E:XP � LIMITS <br />LTR ( {MMIOD/YYYYJ_' IMMIDDIYYYYj <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS-MADEI—XI OCCUR <br />X <br />52SBMPW6890 <br />03/20/2016 <br />03/20/2017 <br />DAMAGE -To .— <br />pRFN415E5 E[ aecotrrpn�e] <br />$ 1,000,000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL R ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,004 <br />I <br />X POLICY E] PRO- <br />JECT LOC <br />PRODUCTS -COMP/OP AGG <br />_ <br />E 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />$ <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />PROPERTY DAMAGE <br />IPeraxl¢eRt]` <br />E <br />I <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE <br />E <br />AGGREGATE_ <br />EXCESS LIAB CLAIMS -MADE <br />E <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? H <br />NIA <br />— <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory In NH) <br />Ir yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The City of Roslyn, its officials, employees and agents are listed as additional insureds <br />CERTIFICATE HOLDER <br />The City of Roslyn <br />ACORD 25 (2014/01) <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />