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® DATE(MMIDOmYY) <br /> ACC]RE3 CERTIFICATE OF LIABILITY INSURANCE <br /> f�. 12/14/2020 <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 <br /> NAME: MaryJo Lozano <br /> Calrose Insurance Inc (A/C,o,Extl: (425)252-5188 (A/FAX Npli <br /> 2231 Broadway AIL <br /> ADDRESS: maryjo@calroseins.com <br /> Everett,WA 98201 INSURERS)AFFORDING COVERAGE No�AIC# <br /> INSURER A: The Princeton Excess&Surplus Lines Insurance 10786 <br /> INSURED INSURER B: <br /> J Squared, Inc. <br /> DBA Sporty's Beef&Brew INSURER C: <br /> 6503 Evergreen Way -`INSURER D <br /> Everett,WA 98203 INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 00034282-499484 REVISION NUMBER: 1 <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 ADM SUBRI POLICY EFF POLICY EXP <br /> TYPE OF INSURANCE <br /> LTRINSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY Y ;JQA3CM000000801 07/24/2020 07/24/2021 EACH OCCURRENCE $ 1,000,000 <br /> r DAMAGETO RENTED <br /> CLAIMS MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> _ ! PERSONAL&ADV INJURY $ 1 Q00,000 <br /> GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY JCT L LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOSHIRED PROPERTY <br /> AUTOS ONLY AUTOS ONELYY j JPerr accidentLMAGE <br /> i $ <br /> UMBRELLA LIAR OCCUR ! EACH OCCURRENCE $ <br /> EXCESS LIAR CLAVMS-MADE AGGREGATE <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER ((OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE _.LER <br /> Y/N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE II N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below _ I EL.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Premesis Location:6503 Evergreen Way,Everett,WA 98203 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> City of Everett, its officers,employees and agents ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1502 Rucker Ave <br /> Everett,WA 98201 AUTHORIZED REPRESENT TIVE <br /> (MJL) <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> Printed by MJL on December 14,2020 at 02:43PM <br />