SHJ25-005 Super1 Pharmacy Agreement - NEEDS SUPER 1

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ROSAUE7 OP IDR EC DATE IMMIDD/YYYYI 08112/2024 ,d►COR® CERTIFICATE OF LIABILITY INSURANCE `..� 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER 609.467-3604 URM Insurance Agency, Inc. P.O. BOX 3365 cONEACT Elizabeth Connelly PHONE 609.467-3604 FAX A/C, No, Ext : IAID, No I ighlbB :econne y urms ores.COm Spokane, WA 99220-3365 Elizabeth Connely INSURERS AFFORDING COVERAGE NAIC # INSURERA:The North River Insurance CO MINsusuREO osallers Supermarkets, Inc. Carla InamaBox RERa:Admiral Insurance Group INSURERC US Fire Insurance 90 P.O. 00 Spokane, WA 99209 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ljiL rypE OFINSURANCE DDL NSD UBR Me POLICY NUMBER POLICY EFF MMlDDJYYYYI POLICY UP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 5038783749 0713112024 0713112025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PI fLa lmrce $ 300,000 X MED EXP An one person)$ EXCLUDED liquor liability PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LqIMOIT- APPLIES PER: POLICY JEL'T LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea act $ 1,000,000 BODILY INJURY Per arson $ ANYAUTO 1337662055 07131/2024 07131/2026 OWNED SCHEDULED AUTOS ONLY AUU�TOQSS 1XX BODILY INJURY Per accident $ PPeOacaRJYDAMAGE $ A�TOSONLY X AUTOSONLY comp$500 X Coll $1000 A X UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 10,000,000 SSLIAB Le CLAIMS -MADE 5821218153 0713112024 07/31/2025 AGGREGATE $ 10,000,000 DED X RETENTION$ WORKERS COMPENSATION AND EMPLAYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ WandER EMBER EXCLUDED? I NIA PER STAT E ERH E.L. EACH ACCIDENT $ E.L. DISEASE-EAEMPLOYE $ E.L. DISEASE -POLICY LIMIT I $ If yes, tlescnbe untler DESCRIPTION OF OPERATIONS below B Druggist Liability E0000038186-07 07131/2024 07131/2025 Ea Claim 5,000,000 Aggregate 8,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if mom apace is requinnu PROOF OF INSURANCE Druggist Liability includes coverage for the administration of immunizations at participating Rosauers pharmacies CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom It May Concern y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD