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NEW <br />Renewal of Number <br />POLICY DECLARATIONS <br />No. SE 2016099 <br />Mount Vernon Fire lnsurance Company <br />1190 Devon Park Drive, Wayne, Pennsylvania 19087 <br />A Member Company of United States Liability lnsurance Group <br />NAMED INSURED AND ADDRESS: <br />BARBRA DAVIDSON <br />DBA: EASTON MEMORIAL DAY PARI\DE <br />PO BOX 698 <br />EASTON, WA 98925 <br />POLICY PERIOD: (MO. DAYYR.) From: 05/2512023 To: 0512912023 <br />FORM OF BUSINESS: Non-Profit Corporation <br />BUSINESS DESCRIPTION: Special Event <br />This contract is registered and delivered as a surplus line <br />coverage under the insurance code of the state of <br />Washington, Title 48 RCW. lt is not protected by any <br />Washington state guaranty association law. <br />fd.W {, ##r-8 <br />12:01 A.M. STANDARD TIME AT YOUR <br />MAILING ADDRESS SHOWN ABOVE <br />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED <br />THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br />Commercial Liability Coverage Part <br />PREMIUM <br />$715.00 <br />Wholesaler Broker Fee <br />Surplus Lines Tax <br />Stamping Fee <br />TOTAL: <br />$50.00 <br />$15.30 <br />$0.77 <br />$781.07 <br />Coverage Form(s) and Endorsement(s) made a part of this policy at time of issue <br />See Endorsement EOD (1/95) <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE <br />WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br />Agent: <br />Broker: <br />TAPCO. KL (5576) (5576) <br />PO Box 286 <br />Burlington, NC 27216 <br />Lael lnsurance & FinancialServices lnc <br />2301 W Dolaruray Rd <br />Ste 5 <br />Ellensburg, WA 98926 <br />THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, <br />I tpn /nR_n7l covERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, TSSUED TO FORM A PART THEREOF, <br />COMPLETE THE ABOVE NUMBERED POLICY. <br />lssued: 03l0gl2023 8:53 AM <br />\d"-' <br />By:Authorized