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for DATE(MM/DD/YYYY) <br /> l CERTIFICATE OF LIABILITY INSURANCE 03/02/2022 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE <br /> AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE <br /> ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, <br /> subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does <br /> not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT NAME: <br /> GOOSEHEAD INSURANCE AGENCY LLC PHONE (866)877-6250 <br /> 46508962 (800)474-1377 FAX <br /> (A/C,No,Ext): (A/C,No): <br /> 1500 SOLANA BLVD BLD 4 4500 <br /> E-MAIL ADDRESS: <br /> WESTLAKE TX 76262 <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Hartford Underwriters Insurance Company 30104 <br /> INSURED INSURER B: <br /> SOUTH FORK BAKING COMPANY,LLC INSURER C: <br /> 1711 COLBY AVE <br /> EVERETT WA 98201-2031 INSURER D: <br /> INSURER E: <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 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 <br /> TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1,000,000 <br /> PREMISES(Ea occurrence) <br /> X General Liability MED EXP(Any one person) $10,000 <br /> A 46 SBA AP7CZU 03/02/2022 03/02/2023 PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> JECT <br /> OTHER: <br /> AUTOMOBILECOMBINED SINGLE LIMIT <br /> LIABILITY <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) <br /> ALL OWNED SCHEDULED <br /> BODILY INJURY(Per accident) <br /> _AUTOS AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS AUTOS (Per accident) <br /> _ UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS- AGGREGATE <br /> MADE <br /> DED RETENTION$ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ANY Y/N E.L.EACH ACCIDENT $1,000,000 <br /> A PROPRIETOR/PARTNER/EXECUTIVE N/A 46 SBA AP7CZU 03/02/2022 03/02/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> (Mandatory in NH) <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS below <br /> A Employment Practices Liability 46 SBA AP7CZU 03/02/2022 03/02/2023 Each Claim Limit $25,000 <br /> Insurance Annual Aggregate Limit $25,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Those usual to the Insured's Operations. <br /> CERTIFICATE HOLDER CANCELLATION <br /> For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> 1711 COLBY AVE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED <br /> EVERETT WA 98201-2031 IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> 03'7 Caaz2 > <br /> ©1988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />