Liquid Provisions dba Grape & Grain 11/23/2021

ACC DATE(MM/DD/YYYY) �,,.. CERTIFICATE OF LIABILITY INSURANCE 11/22/2021 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). CONTACT PRODUCER Liberty Mutual Insurance NAME: PO Box 188065 PHONE FAX Fairfield, OH 45018 E-MAIL No.Ext): 800-962-7132 (A/C,No): 800-845-3666 ADDSS: BusinessService@LibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Ohio Security Insurance Company 24082 INSURED INSURER B: Liquid Provisions, LLC DBA The Grape And Grain INSURER C: 6502 Evergreen Way INSURER D: Everett WA 98203 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 65123220 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A ✓ COMMERCIAL GENERAL LIABILITY ✓ BKS62354013 12/14/2021 12/14/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �/ OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY JECOT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAS62354013 11/16/2021 12/14/2022 Te aoc den tSINGLE LIMIT $1,000,000 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$ $ A WORKERS COMPENSATION BKS62354013 12/14/2021 12/14/2022 PEA OTH TUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) St0 Gap E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under p p DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Everetts officers,officials,employees,and agents are listed as Additional Insured Owners,Lessees or Contractors per form CG2010. 30*Day Notice of Cancellation*10 Day Notice of Cancellation for Cancellation for Non-Payment of Premium CERTIFICATE HOLDER CANCELLATION Cityof Everett, its officers, officials, employee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and agents ACCORDANCE WITH THE POLICY PROVISIONS. 2930 Wetmore Ave Everett WA 98201 AUTHORIZED REPRESENTATIVE Brittany Cochran ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 65123220 162354013 121-22 GL AU WC 1 Brittany Cochran 1 11/22/2021 7:35:41 PM (EST) 1 Page 1 of 5