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RTOWCOM-01 BROBERTS <br />A RD¯ <br />CERTIFICATE OF LIABILITY INSURANCE DAT9E(MM/2DDIY6YYY) <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(ies)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 <br />N Brian Roberts <br />4 8 h <br />S.kS <br />Suite 206 iN .Ex11:(425)968-2236 No}:(818)827-3380 <br />Lynnwood,WA 98036 ESS brian@bluelionbrokers.com <br />INSURER{S)AFFORDING COVERAGE I NAIC & <br />INSURERA:Sentinel Insurance Co LTD 11000 <br />INSURED INSURER B : <br />RTown Community INSURER C : <br />PO BOX 197 INSURER D : <br />Roslyn,WA 98941 INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIESOF 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 ADDLISUBW POLICY EFF POLICY EXP <br />LTR TYPE OF INSURANCE INSD Wvp [POLICY NUMBER (MM/DDIYYYY)(MMIDDIYYYY),LIMITS <br />A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br />CLAIMS-MADE X OCCUR X 52SBMPW6890 03/20/2016 03/20/2017 Šggg|p g 1,000,000 <br />MED EXP (Any one person)$10,000 <br />i PERSONAL &ADV INJURY i $1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE s 2,000,000 <br />X POLICY EC LOG PRODUCTS -COMP/OP AGG $2,000,000 <br />OTHER I <br />AUTOMOBILE LIABILITY aM NED SINGLE l.FMFT <br />ANY AUTO BODILY INJURY (Per person)$ <br />ALUL OSWNED i H ULED BODILY INJURY (Per accident)$ <br />I NON-OWNED PROPERTY DAMAGE <br />HIRED AUTOS ,AUTOS (Por accident} <br />$ <br />i UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br />l EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $$ <br />WORKERS COMPENSATION PER OTI-i- <br />AND EMPLOYERS'LIABILITY Y I N <br />STATUTE ER <br />ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ <br />OFFICER/MEMBER EXCLUDED?N I A i <br />(Mandatory In NH)E.L.DISEASE -EA EMPLOYEE $ <br />If es,describe under <br />D SCRIPTION OF OPERATIONS below I I E.L.DISEASE -POLICY LIMIT $ <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 IIsted as additional insureds <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED INTheCityofRoslynAccoRDANCEWITHTHEPOLICYPROVISIONS. <br />AUTHO <br />©1988-2014 ACORD CORPORATION.AII rights reserved. <br />ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD