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LIQUID PROVISIONS LLC 11/1912', 12-27 P1'= <br /> r •rri <br /> r1.1 <br /> srarr©r wASHINGTON <br /> Department of Labor & Industries <br /> Certificate of Workers' Compensation Coverage <br /> November 19, 2021 <br /> WA UBI No. 604 612 939 <br /> L&I Account ID 972,249-00 <br /> Legal Business Name LIQUID PROVISIONS LLC <br /> Doing Business As GRAPE AND GRAIN <br /> Workers' Comp Premium Status: Call L&I account representative for account <br /> status. <br /> Estimated Workers Reported Incomplete premium report received. <br /> (See Description Below) <br /> Account Representative Employer Services Help Line, (360) 902- <br /> 4817 <br /> Licensed Contractor? No <br /> What does "Estimated Workers Reported" <br /> mean? <br /> Estimated workers reported represents the number <br /> of full time position requiring at least 480 hours of <br /> work per calendar quarter. A single 480 hour <br /> position may be filled by one person, or several part <br /> time workers. <br /> Industrial Insurance Information <br /> Employers report and pay premiums each quarter <br /> based on hours of employee work already <br /> performed, and are liable for premiums found later <br /> to be due. Industrial insurance accounts have no <br /> policy periods, cancellation dates, limitations of <br /> coverage or waiver of subrogation (See RCW <br /> 51.12.050 and 51.16.1 0). <br /> hops://secure.Ini.vra.goviverify/Details/IiabililKertificate.aspx?UBI=604612939&LIC=&V10=&SAW=false&ACCT=97224900 Page 1 of 1 <br />