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ACCGREP <br /> DATE(MM/DD/YYYY) <br /> �....-- CERTIFICATE OF LIABILITY INSURANCE 09/15/2020 <br /> 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 <br /> 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), <br /> AUTHORIZED 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.If SUBROGATION IS WAIVED,subject to the terms and <br /> 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). <br /> PRODUCER CONTACT <br /> NAME: <br /> Jeffrey Westphal(7926323) PHONE FAX <br /> 2820 Oakes Ave Ste D (A/C,NO,ExT):425-330-1148 (A/c,No):888-265-5038 <br /> E-MAIL <br /> Everett WA 98201-3667 ADDRESS: jwestphal@farmersagent.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Truck Insurance Exchange 21709 <br /> INSURER B: Farmers Insurance Exchange 21652 <br /> THE INDEPENDENT BEER BAR,LLC INSURERc: Mid Century Insurance Company 21687 <br /> 1801 HEWITT AVE <br /> INSURER D: <br /> INSURER E: <br /> EVERETT WA 98201 <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 NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY <br /> 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 <br /> POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED <br /> PREMISES(Ea Occurrence) 75,000 <br /> MED EXP(Any one person) $ 5,0001 <br /> A Y N 606782382 02/12/2020 02/12/2021 PERSONAL&ADVINJURY $ 1 000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PROJECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED AUTOS SCHEDULED <br /> ONLY AUTOS N BODILY INJURY(Per accident)$ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> ONLY AUTOS ONLY (Per accident) <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTHER $ <br /> AND EMPLOYERS'UABILITY STATUTE <br /> ANY PROPRIETOR/PARTNER/ YIN N/A E.L.EACH ACCIDENT $ <br /> EXECUTIVE OFFICER/MEMBER <br /> EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under DESCRIPTION OF <br /> OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <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 are listed as additional insured <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITY OF EVERETT COMMUNITY DEVELOPMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> 2930 WETMORE AVE SUITE 8-A DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE JULIE STAHLER <br /> FvERFZT WA 9870.1_ <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved <br /> 31-1769 11-15 The ACORD name and loao are reaistered marks of ACORD <br />