Buzz Inn Inc dba Buzz Inn Steakhouse 12/29/2020

CERTIFICATE OF LIABILITY INSURANCE MM/DD/YYYY) ao U N C E DATE( 1211 a/2o20 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 have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT Linda Minami,CPCU,ARM NAME: Bell Anderson Agency.Inc. PRONE (425)291-5200 FAX (425)291-5100 (A/C,No,Ext): (A/C,No): 600 SW 39th St,Suite 200 E-MAIL Iindam@bell-anderson.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Renton WA 98057 INSURER A: Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B: Employers Insurance Company of Wausau 21458 J.D.W.Inc.,DBA:Buzz Inn Management Company INSURER C: 18950 State Route 2 INSURER D Suite 146 INSURER E: Monroe WA 98272 INSURER F COVERAGES CERTIFICATE NUMBER: CL2022739498 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM!DD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X.OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A TB2-291-468531-020 03/01/2020 03/01/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JERT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY{Per person) $ ._.__ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY �- AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE _ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B LIQUOR LIABILITY TO2-Z91-468531-040 03/01/2020 03/01/2021 EACH OCCURRENCE $1,000,000 AGGREGATE $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:1321 Broadway,Everett,WA-CARES Act Grant City of Everett,its officers,employees and agents are additional insured per the attached endorsement#LC2062 0117. Waiver of subrogation per the attached endorsement#LC0447 0117. Primary&non-contributory coverage per the attached endorsement#LC2062 0117. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Everett ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore Avenue Suite 10A AUTHORIZED REPRESENTATIVE Everett WA 98201 J - 7,1".e.‘.0 ©19884015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD