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Hanover <br /> Insurance Group- <br /> VILLAGE THEATRE ZD2 A738713 03 t: <br /> ARTHUR J. GALLAGHER RISK <br /> Liquor Liability Coverage Declaration <br /> Limits of Insurance: <br /> Liquor Liability Aggregate Limit $1,000,000 <br /> Each Common Cause $1,000,000 <br /> LOC ST TERR CODE SUBLINE PREMIUM BASIS PER RATE ADVANCE PREMIUM <br /> 1 WA 502 58161 332 25224 Gross Sales 1000 3.189 $80.00 <br /> Additional for Coverage Minimum $170 <br /> Total Advance Commercial Liquor Liability Premium $250.00 <br /> Forms Applicable to Liquor Coverage Parts <br /> Form Number Edition Date Description <br /> CG 00 33 04/13 Liquor Liability Coverage Form <br /> CG 28 99 01/96 Washington Changes <br /> 421-0342 01/05 Page 15 Issued 09/26/2018 <br /> Original Insured <br />