|
_____,
<br />IJ"1E11 ·aurif¥'1", ACORD
<br />~ CERTIFICATE OF LIABILl1Y INSURANCE 07B0/201 9
<br />lliSlfJ<OOtAtEISIISSlJEDl&AWJlfR~11ka:l!il'.MliHllM£1NllWlll!ilill<rollRJ511tD!l1!lll\HSUPCllll~Bl!ll!lilEl!l711111S
<br />CERTflOffE 00e5ii'IOI' ~ OIUEG\'llMI.Y ~eGEN[) OIAUERn£aMJV.6ENroK)ED BYlliE POUCIE5Bl:W#.11tfl5
<br />CBltlROJEOF~IXSNCfO!lN51JTUTEll.~~llEIS!iUIM61HSUR!311Sl.MllltORUB)~OR
<br />-
<br />IIIPORTN«: IJh~~ll!.an~ ~ lhtpclk:j(l,e!i) m&lStbe~ t~ ISWAMD. d(m:l'Alill!
<br />tfflnsandcmclllcr51lfthepolcy, cetlh~mr/rtllllfrl~~Astitementon!JllsC!!llllcUdoesllOCCIJlffl'~tDtli,t,
<br />PRODUCER coma
<br />tw.e
<br />NASW RRG Plan Administrator !'l!l 'ICMt li:.-I 1.200 IE~ Gllem A\l'.ll'nli!te Wt:111,,,Ellt:
<br />p . Herghts., IL 61616-53148 E<WUl
<br />~
<br />UiSlJREll!S)~ CD'IERAGE WIIC#
<br />INS'U!!ED ~ 'l..'U..\P/ll(e,1(\Rt 11t•,l/11w 1(;,i(>tlIO 14?,!;,6
<br />l<nsu l 1-luniJker lNSUIERB;
<br />3204 5ummiruew Ave IIN'CI-C
<br />Va'r,I11.;, \ 9S002 1115Wl1191:llll ' lliSltlllfRE:
<br />\JISUl£R F!
<br />CUSTOMER ID: 3JDIS'J2CJX .. ' -RB'tSTON NUMBER: oo
<br />rH 6 IO m.,,.-, m,,r flilf ,DUOi:S OF fNSUR'INClf u;,Q'l) IBfllOW l<ti\ltE 13l'l'N l'SStllff' m, li14t' INSU\iB)l l\!11,Ml'l) -~O'Vi: Fo~· nili' FOU(¥' WS.IOID 1'1011!:A l'l'O<.
<br />' IW\HIS"i' ... f lllc.QUIREM~W, TE.RM Oil, ION. Of AW Cl')"fT fMG OR OT>lffi OOCIJWJH l?IIT11 Rf..~Pt.CI TO WHl<J-, TH& CU-./Tllf~U. !l/.:t IJE
<br />;SLE) " Yf'E\l-\ltl n-11:INSllRANff .MTOll[ll.."l)fJ,'f f)ilr WOLK131Df'.',,';:~l:3ff) liffiBN l':.st.ili;.fff f':l ALt IHf' ra.M:,, l:'X:::Lf,,51.0~1•11.,u;; (•Jl\ll[lf., ".S,.OFSlKH
<br />"""''" ""-J,J!,.i;,~ ,rWl\""''''~"'1• ... ,"J 1i>.rt<N .,,1,m11(1111l lll'f1Jll ll l'ILAI It(;
<br />m>ea:~ AIXl. 5USR l'GI.JlO',NIJMB lf'OIJC( roocY UMilS
<br />IJR -WlO ll3fF ErJ>
<br />~Uotelm' I -......... -~ -
<br />UJl.l t.151.<Ullt~L l\ IIDA'l~1<6rto ,l,C .\1!,1>17,e\:ll1\!E:l>JIIIIE,S 'i, -o ~C'CL!, 'l!:<>"-",..,...'·'\'l
<br />O.~S~A'Ul: MEC.1 E.f.P {ild, ~--~l t -ff'U-~MSIIVOf 'iU<SC""'" ,_.._.,., UI JL..~ s
<br />CA!,~11\l..<l<•~n.· ~ -mt.1-'l<Om i~r.il!lllU:\,-~\llb i
<br />~ • HG<in<H,ill't iJlldlif Al~O\.if', l'tl'< ~
<br />7 ~(1/..Q n r-w:v.r.t n i..'X:.
<br />~~ rnhJliJNl!f.!Sll!lo;I.IEI.JMli t
<br /><fn,w..-.
<br />.\._'Yl'IV7C -iftlClilll:lffl,iflTIJ', .. ~=· s -SlnE :U,f!> 1•11.lOWNEll AIJT ~ B.'<.1'.11411\)11'~'"~ ~ -,1u.T-OS -,nJ111 .. U.~Wl«Jl, Mlll H>'tvN1.."1ll "r~~1lff .,.!Qn,'lif1?i'EJC ~
<br />•fi!'K ;-k..>.,.11u1.....-
<br />~ rnt !4~-~~ $ --~•rr $ ·-_:, ... M,.1,(1,:, -mI)n J~
<br />$
<br />j
<br />WORl<BISCOMPEt&,llOO l -wc:STA"7"11T [JR'.r llfMl!f.::.~ Jo-HB<
<br />~ Et,APlO'VSlS' YIN H . EJ.Oi Al'rmeJI s
<br />I"-' '1""°"' 'o;IJl'lfll Nffii D lfC. !!,16tC•~1[-~A-C/!1:[l'tJ1f·Ui1'~.rr~ ' L~l'Jl.1' ~~W.a'lillllilWISli\>
<br />ontlfllf.tl.~ lf'f(i'."'.t.. r._'Y ~.,µJin .. .: Ell. on;t.8.5~ -F10UO'!'..l~l;r $
<br />(Mafflcfatoilylh ll'Nl!i'll.Cr 'G!00\'ll11irff~r,t4;ll:
<br />IPnxkssm.al L';iMr1 ~raiv.e
<br />f'~r r1..1bln"l lUi'nR S 1,1".¢ "')), .lU
<br />A R:e,;ro,xl1'te [l.i,;e·:03-05-1011' 'ii'' N p.]1!,UjJ;f.}15[311"1'0~©2' 00tWW 1":l> {13.lOo/'20:..~ ' /\ggyitg~l" tlrni! ~
<br />Slaie, l<•~ il(.;.tG l1m11,-. 1::1!,.\l'OllC
<br />IDi:SCH.11'1101• 01' 1](1-"E;AA'laoos ,Y 1.00\llQhlS 1\/[KUOLlS ~ ~Ul<UI ::.ui., Xddittoml IReTT\.,,.ks; 5'1:hedl!f\e, r.ooy1ne ,.Jt!t-aclrred !tf nrncme ~nace if~r:equh:-.e~J
<br />CBmRCATE HOLOER CANCB..1.AllON
<br />DCYF 5110il.0 N«OFTIE~ OE'SOllSED POLICIES BE
<br />1 661 Fowlff St CANCB.LED BEFORE.THE~ CW£1Hl:ll8Jf,
<br />Rkh;ird WA 99352 NOTICE \W.J.. BE DB.IVERB) ON ACXOtlfW«:E WITH
<br />PCXJO'l'RCMSlONS.
<br />~Pe-P l•UTHO!ml:D
<br />~El' 5 n 11m1:
<br />ACORD 25 (2010105) @ 19sa.2U10 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are regisl:ered ma:r1<s of A.CORO
|