Eight Ball Cafe 8/15/2022 - Laserfiche WebLink

Aco D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L.---- 05/13/2022 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 Andrew Pettygrove Sandin Insurance Group NAME: PO Box 230785 INC,PHONE NoExtl: (503)899-9632 FAX No): (503)926-9193 ADDRESS_ andrew@teamsandin.com Portland, OR 97281 -.- ----- License#: CA 0G94457 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: General Casualty Company of Wisconsin 24414A INSURED Eight Ball Cafe LLC INSURERS: DBA Eight Ball Cafe INSURERC: 2727 Colby Avenue INSURERD: Everett,WA 98201 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00003461-16519 REVISION NUMBER: 1 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD END (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y BBP0021594 03/21/2022 03/21/2023 EACH OCCURRENCE $ 2,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 300,000 X Liquor Liability MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JEo LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: Liquor Liability $ 2,000,000 A AUTOMOBILE LIABILITY BBP0021594 03/21/2022 03/21/2023 COMBINED SINGLE LIMIT(Ea accident) $ 2,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION BBP0021594 03/21/2022 03/21/2023 X STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Joggt LLC-DBA:Wolf Bay Asset Managmenet is listed as an additional insured-managers/lessos-CG2011 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Joggt LLC - DBA: Wolf Bay Asset Management ACCORDANCE WITH THE POLICY PROVISIONS. 1200 Wesetlake Ave N #608 Seattle, WA 98109 AUTHORIZED REPRESENTATIVE /2F ©1988-2015 ACORD CORPORAT �"` I rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by AJ• on /13/2022 at 05:59AM