Austin Java/Expresso Americano 6/15/2016

W-®® ACERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �—� 06/03/2016 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 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 Traci Wills NAME: Renee Corwin Rey(7909M29) WC,No.Ext): 360-414-8754 FAX No, 360-232-8536 805 Ocean Beach Hwy E-MAILDSS: traci.rcorwinrey O(7,farmersagency.com_ INSURER(S)AFFORDING COVERAGE j NAIC S Longview WA 98632-4071 INSURER A: Truck Insurance Exchange 21709 INSURED INSURER B: _ INNOVA CORP INSURER C: dba ESPRESSO AMERICANO INSURER D: I _ 8690 WOLFF CT#200 INSURER E: WESTMINSTER CO 80031 INSURER F: COVERAGES CERTIFICATE NUMBER: 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''. IADDL;SUBR1 POLICY EFF j POLICY EXP LTR TYPE OF INSURANCE 1INSR I WVO I POLICY NUMBER (MMIDD/YYYYI i(MMIDD/YYYY) LIMITS ,r GENERAL LIABILITY I i I I EACH OCCURRENCE I S 1,000,000 AMAGE TO RENTED X COMMERCIAL GENERAAL/LIABILITY i PREMISES(Ea occurrence) S 250,000 �CLAIMS-MADE X i OCCUR I MED EXP(Any one person) S 5,000 I A Y Y 606282902 106/03/2016 06/03/2017 I PERSONAL&ADV INJURY $ 1,000,000 I IGENERAL AGGREGATE s 2,000,000 GENt AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS-COMP/OP AGG S 2,000,000 X I POLICY I E0. 7 LOC I I I S r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 15 1,000,000 000 ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED A I AUTOS AUTOS 606282902 06/03/2016 06/03/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X I HIRED AUTOS X AUTOS (Per accident) $ 1 •• $ 1 UMBRELLA LIAB IIOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 1 1 S 1 1 DED I RETENTIONS , I I$ I WORKERS COMPENSATION I I WC STATU- OTH- FANO EMPLOYERS'LIABILITY Y I N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT I S OFFICER/MEMBER EXCLUDED? N/A ,(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S I I I I I . DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Location:3201 Smith Ave,Everett,WA 98201. Includes equipment at location included in lease agreement. Additional insured form BP0402 01/87 attached. This form is subject to policy terms,conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF EVERETT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3200 Cedar St AUTHORIZED REPRESENTATIVE Everett WA 98201 aa_(o ar ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD