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_____,--.141 ` LSBREWI-01 KMORRISON
<br /> ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> `....----- 8/17/2020
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Krys Morrison
<br /> NAME:
<br /> PLC insurance LLC PHONE FAX
<br /> 19401 40th Ave W,Suite 440 (A/C,No,E):(425)275-0564 (A/C,No):
<br /> E-MAIL k@plcins.com
<br /> Icins.com
<br /> Lynnwood,WA 98036 ADDRFss_rY @P
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Mutual of Enumclaw Insurance 14761
<br /> INSURED INSURER B: '
<br /> LS Brewing Inc INSURER C:
<br /> 715 100th St INSURER D:
<br /> Everett,WA 98208
<br /> INSURER E: _
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR, ADDL SUER POLICY EFF POLICY EXP
<br /> TYPE OF INSURANCE POLICY NUMBER LIMITS
<br /> LTR INSD WVD IMM/DD/YYYY) (MM/DD/YYYYI
<br /> A , X ' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE X OCCUR 'CPP0022344 5/1/2020 6/27/2020 DAMAGE TO RENTED 300 000
<br /> PREMISES(Ea occurrence).__- $
<br /> MED EXP(Any one person) $ - 10,000
<br /> PERSONAL 8 ADV INJURY $
<br /> 1,000,000
<br /> 000
<br /> PRODUCTS-COMP/OPAGG $ ---2 ,
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE i
<br /> POLICY!' JECOT- LOC $ 2,000,000
<br /> OTHER:
<br /> WA STOP GAP $ 1,000,000
<br /> A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , 1,000,000
<br /> I-_"-I (Ea accident) $
<br /> X 1 ANY AUTO CPP0022344 5/1/2020 6/27/2020 BODILY INJURY(Per person) $
<br /> OWNED ', SCHEDULED
<br /> _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ _ -
<br /> I E ED PROPERTY DAMAGE
<br /> AURTOS ONLY NON
<br /> S ONLY (Per accident) $
<br /> $
<br /> A X UMBRELLA LIAB I,..X.I OCCUR EACH OCCURRENCE $ 1,000,000
<br /> EXCESS LIAB 1—j CLAIMS-MADE'' UMC0005514 5/1/2020 6/27/2020
<br /> AGGREGATE y$ 1,000,000
<br /> RETENTION$ $
<br /> WORKERS COMPENSATION '� I PER 1 OTH-
<br /> AND EMPLOYERS
<br /> 'LIABILITY YIN i.STATUTE_:_ ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE rI-- EL.EACH ACCIDENT ,.$
<br /> (MandatoryOFFICER/MEMBER
<br /> BENH EXCLUDED? t. __] NIA ---- ---
<br /> E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under
<br /> i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A General Liability CPP0022344 5/1/2020 6/27/2020 Liquor 1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> City of Everett,its officers,employees and agents as additional Insured for the duration of the program are named additional insured per written contract or
<br /> agreement with respects to the General Liability. Waiver of Subrogation and Primary& Contributory applies.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Cityof Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 2930 Wetmore Ave
<br /> Everett,WA 98201
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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