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Certificate of Insurance
0ACOROCERTIFICATEOFLIABILITYINSURANCEDATE(MMIDO(YYYfl10122/2019C—THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDERTHISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDERIMPORTANT:Ifthecertificateholder’sanADOmONALINSURED,thepo(lcy(ies)musthaveADDrnONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,subjecttothetermsandconditIonsofthepolicy,certaInpolicIesmayrequireanendorsementAstatementonthiscertificatedoesnotconferrightstothecertificateholderInlieuofsuchendorsement(s).PRODUCER2LACTKathyKaneHUMBLE&DAVENPORTINSBROKERSINCTIO.EatI:(425)226-6221INot:(425)255-93423500MapleValleyH’ADDRESS:kathyk©humbledavenport.comINSURERIS)AFFORDINGCOVERAGENAICRentonWA98058INSURERA:UnitedSpecialtyInsuranceCompanyINSUREDINWRERS:AnaiyahHomesLLCINSURERC:1402LakeTappsPkv.ySE.Ste1044165INSURER0:INSURERE:AuburnWA98092INSUP5F:COVERAGESCERTIFICATENUMBER:CL18122122871REViSIONNUMBER:THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORThEPOLICYPERIODINDICATED.NOTWiTHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWiTHRESPECTTOWi-IICHTHISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,EXCLUSIONSANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS.iNRODELUaRPOLICYEFFPOLICYEXPLW—WPEOFINSURANCEINSOPOLICYNUMBERIMM/DDTYYtY)(MMIDDFrYYY)LIMITS)(COMMERCIALGENERALLIABILI7VEACHOCCURRENCE$1,000,0001DAMAGETORENTED50000CLAIMS-MADE[JOCCURPREMISES(Escccurencel$MEDEXPlAnyonepenon)10.000A—DBRUS000797-0012/20/201812/20/2019PERSONALLADVINJURY1,000,000GENtAGGREGATEUMITAPPLIESPERGE?ERALAGGRE3ATEs2,000,000POLICYD&DLOCPRODUCTS-CCMP/OPAGGs2,000,000..LOTHER——EmployeeBenefitsAUTOMOBILEUABIUWCOMENEDSNGLELIMITANYAUTO000LYINJ’JRYIPrPnQI$AUTOSONLYDSCHEDULEDBODILYINJURYIPOrOCIdBnI)SHIREDNON-OtEDPROPERTYDAMAGE$AUTOSONLYAUTOSONLY(Peraccuenl)SUMBRELLAUABLiOCCUREACNOCCURRENCESEXCESSLIABCLAIMS-MADEAGGREGATE$DEDIIRETENTION$—SWORKERSCOMPENSAI1ON—PEROTHANDEMPLOYERS’UABIUTYYINSTATUTEERANYPROPRIETORIPARTNER/EXECUTIVEELEACHACCIDENT$OrnCERtAEMBEREXCLUDED?NM(MandaloryInNH)ELDISEASE-EAEMPLOYEES:1yea.dasoibeDESCRIP11ONCFOPERATiONSblcw—ELDISEASE-POLICYUMITSDESCRIPTIONOFOPERA’RONStLOCATIONS(VEHICLES(ACORD101,AddItIonalRemantsSchedule,maybeattachedIFmorespateIsisquired)TheCertifICateholderisnamedasadditionalinsuredwithrespectstotheoperationsofthenamedinsuredperfDrmTMGL172.Coverageisprimaryandnon.CDnhibutoryCERTIFICATEHOLDERCANCELLATIONSHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDINCityofRentonACCORDANCEWITHTHEPOLICYPROVISIONS.1055SGradyWyAUTHORIZEDREPRESENTATIVERentonWA98057©1988-2015ACORDCORPORATION.Allrightsreserved.ACORD25(2016103)TheACORDnameandlogoareregIsteredmarksofACORD TMGL17210/11PolicyNumber:DBRUS000797-00EffectiveDate:12/20/201812:52:00PMADDITIONALINSURED—OWNERS,LESSEESORCONTRACTORS—AUTOMATICSTATUSWHENREQUIREDINCONSTRUCTIONAGREEMENTWITHYOU(PRIMARY&NONCONTRIBUTORY)Thisendorsementmodifiesinsuranceprovidedunderthefollowing:COMMERCIALGENERALLIABILITYCOVERAGEPARTA.SectionII-WhoisAnInsuredisamendedtoincludeasaninsuredanypersonororganizationforwhomyouareperformingoperationswhenyouandsuchpersonororganizationhaveagreedinwritinginacontractoragreementthatsuchpersonororganizationbeaddedasanadditionalinsuredonyourpolicy.Suchpersonororganizationisanadditionalinsuredonlywithrespecttoliabilityfor“bodilyinjury”,“propertydamage”or“personalandadvertisinginjury”caused,inwholeorinpart,by:1.Youractsoromissions;or2.Theactsoromissionsofthoseactingonyourbehalf;intheperformanceofyourongoingoperationsfortheadditionalinsured.Apersonsororganizationsstatusasaninsuredunderthisendorsementendswhenyouroperationsforthatadditionalinsuredarecompleted.B.Withrespecttotheinsuranceaffordedtheseadditionalinsureds,thefollowingadditionalexclusionapply:Thisinsurancedoesnotapplyto:I.“Bodilyinjury”,“propertydamage”,“personalandadvertisinginjury”arisingoutoftherenderingof,orthefailuretorender,anyprofessionalarchitectural,engineeringorsurveyingservices,including:a.Thepreparing,approving,orfailingtoprepareorapprove,maps,shopdrawings,opinions,reports,surveys,fieldorders,changeordersordrawingsandspecifications;orb.Supervisory,inspection,architecturalorengineeringactivities.2.“Bodilyinjury”,“propertydamage”occurringafter:a.Allwork,includingmaterials,partsorequipmentfurnishedinconnectionwithsuchwork,ontheproject(otherthanservice,maintenanceorrepairs)tobeperformedbyoronbehalfoftheadditionalinsured(s)atthelocationofthecoveredoperationshasbeencompleted;orb.Thatportionof“yourwork”outofwhichtheinjuryordamageariseshasbeenputtoitsintendedusebyanypersonororganizationotherthananothercontractororsubcontractorengagedinperlormingoperationsforaprincipalasapartofthesameproject;orC.“PropertyDamagewhichmanifestsafterexpirationofthePolicy.Ifrequiredbywrittencontractoragreement,suchinsuranceaisaffordedbythispolicyshallbeprimaryinsurance,andanyinsuranceorselfinsurancemaintainedbytheaboveadditionalinsured(s)shallbeexcessoftheinsuranceaffordedtotheNamedInsuredandshallnotcontributetoit.ALLOTHERTERMS,CONDITIONSANDEXCLUSIONSREMAINUNCHANGED.