MITCO-1 OP ID: P1 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/20/13 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 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 endorsement(s). 206-285-7735 206-285-3461 PRODUCER Lovsted-Worthington LLC P.O. Box 607 Bothell WA 98041 424 Third Ave W Seattle, WA 98119 Scott G. Briscoe CONTACT NAME: PHONE (A/C, No, Ext): 425-486-1291 E-MAIL ADDRESS: FAX (A/C, No): 425-486-6140 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Continental INSURED Western Ins Co Travelers Prop Cas Company INSURER B : May International, Inc. DBA: Mitco Ltd 13811 N. Sunset Fountain Hills, AZ 85268 25674 INSURER C : 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 LTR TYPE OF INSURANCE ADDL SUBR INSR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY A X MCP6004879 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X 02/07/13 02/07/14 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PROPOLICY LOC JECT X ANY AUTO ALL OWNED AUTOS HIRED AUTOS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ Emp Ben. AUTOMOBILE LIABILITY A LIMITS MCP6004879 02/07/13 02/07/14 SCHEDULED AUTOS NON-OWNED AUTOS $ $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ $ 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ X A A UMBRELLA LIAB EXCESS LIAB X OCCUR CU6006840 CLAIMS-MADE X RETENTION $ N/A DED WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A Trailer Intrchg B Cargo 02/07/13 02/07/14 EACH OCCURRENCE $ AGGREGATE $ 3,000,000 3,000,000 $ WC STATUTORY LIMITS MCP6004879 02/07/13 02/07/14 WA STATE STOP GAP X OTHER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT MCP6004879 02/07/13 02/07/14 6602807N223 09/22/13 09/22/14 Ded $1000 Ded $5000 $ 1,000,000 1,000,000 1,000,000 50,000 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Operations performed by or on behalf of the named insured. MC634735. CERTIFICATE HOLDER CANCELLATION ASSUREA Assure Assist 543 Country Club Dr, #B338 Simi Valley, CA 93065 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD