HomeMy WebLinkAbout20260210_PJA26-0097_Certificate of Insurance CERTIFICATE OF LIABILITY INSURANCE 1 2/1(112���'Yn`Y'
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 INSURERS), 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 SUBROGATfON IS WAIVED,sit to the terms and conditions of the Policy,certain policies may refire an endorsement A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorse rrent(s).
PRODUCER CONTACT
M :er essive Commercial Lines Customer and-Agent Servid
Progressive Insurance PEE FAX
PO Box 94739,Cleveland,OH 44101 No FxW.1-800-444-487
ooR A ressivecommercial I :.
. ADDRESS:Pro9 Kemal-pr�gressive.com
BISIN (SIAFFORDWGCOVERAGE NAIC'#
i INSURER A:United Financial C4suafty Company 117-70
INSURED
INSURER 8:
BUZZY BEE COFFEE LLC BUZZY BEE COFFEE
12115 STATE AVENUE INSURER C:
MARYSVILLE,WA 9U71 INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:5069497104380891DID021026TOW822 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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-
iNLBRR TYPE OF INSURANCE INSO WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
#MIFI6DVYYYY) YI
COMMERCIAL GENERAL LL49R I1Y EACH OCCURRENCE $ -
CLAIMS-MADE 5,OCCUR PREMISES€a occurrence $
MED EXP(Any one person) S
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
PRO- �j PRODUCTS-COMPIOP AGG $
POLICY F]JECT L�L£3C
OTHER S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) $
ANY AUTO BODILY INJURY Per rsm 25.0W
AUTOS SCHEDULED --BODILY INJURY Peracaddetwt) ^�50,000
OWNED t:#-Y AUTOS N N I L4
`X.AUTOS .52[I6fl 69Pt5t2Q25 fl9f1512U2&
A T�t0.OS.ONLY NON-6 NED e s ct2TY AMAGE $tQ 000
--fl
.. UMBRELLA I" OCCUR EACH OCCURRENCE $
EXCESS LIAB CI.AI AGGREGATE $
pEp RETENTION$ $
_ WORKERS COMPENSATION ri-
AND EMPLOYERS'LIABILfTY Y!I`I E !
ANYPROPRIETORtPARTNERIEXECiWIVE " NIA. E.L.EACH ACCIDENT S
OEEiCERIMEM$EREXCLUOED?
(Mandak"in 90) E.L.DISEASE-EA EMPLOY Ed
If yes,describe under
DEScRiPTioNofopERATIoNSbetew E.L-DISEASE-POLICY LIMIT $
- See ACORD 101 for additional coverage detaf - $
A N N 00246206D 09t1512025 0911512026
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Set ewe,may be aftactied'it more e space is rectigred}
CERTIFICATE HOLDER CANCELLATION
BUZZY BEE COFFEE LLC BUZZY BEE COFFEE SHOL4.D ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
Stephanie N Leoso THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
12115 Slate Avenue ACCORDANCE WITH THE POLICY PROVIS ON5.
C 209
MARYSVILLE.WA 98271
AUTHORIZED REPRESENTATWE
01 15 ACORD CORPORATION, All ri"reserved.
ACORD 25(2016103) The ACORD name and toga are registered marks of ACORD