Loading...
ENP2021-0031-Updated Cert of Insurance-03.22.2021POLICY NUMBER: CPO 0236686-02 COMMERCIAL GENERAL LIABILITY CG 20 13 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS RELATING TO PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF EDMONDS 121 5TH AVE N EDMONDS, WA USA 98020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: 1. The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 2. The construction, erection or removal of 1. Required by the contract or agreement; or elevators; or 2. Available under the applicable limits of 3. The ownership, maintenance or use of any insurance; elevators covered by this insurance. whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 13 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number CPO 0236686-02 Endorsement No. 002 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMON POLICY CHANGE ENDORSEMENT AMERICAN ZURICH INSURANCE COMPANY Named Insured ROASTPANO LLC Effective Date of change: 03-16-21 12:01 A.M., Standard Time Agent Name MCGOWAN & COMPANY, INC. Agent No. 22045-000 This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions of coverage unless at the sole request of the insured. COVERAGE PART INFORMATION -- Coverage parts affected by this change as indicated by 0 below. ❑ Commercial Property ❑ Commercial General Liability NO CHARGE Commercial Crime ❑ Commercial Inland Marine Ll The following item(s): Insured's Name Insured's Mailing Address Effective/Expiration Date Insured's Legal Status/Business of Insured Payment Plan Coverage Forms and Endorsements Add/Delete Vehicle Deductibles Additional Interest Classification/Class Codes Limits/Exposures Underlying Exposure/Insurance Covered Property/Location Description is (are) changed to read [See Additional Page(s)] SEE NEXT PAGE The above amendments result in a change in the premiums as follows: This premium does not include taxes and surcharges. ❑ No changes 0 To be Adjusted at Audit Additional NO CHARGE Return NO CHARGE Tax and Surcharge Changes Additional Return U-GU-614-B CW (10/ 16) Policy Number CPO 0236686-02 Endorsement No. 002 COMMON POLICY CHANGE ENDORSEMENT AMERICAN ZURICH INSURANCE COMPANY Named Insured ROASTPANO LLC Effective Date of Change: 03-16-21 12:01 A.M., Standard Time Agent Name MCGOWAN & COMPANY, INC. Agent No. 22045-000 POLICY CHANGES ENDORSEMENT DESCRIPTION (CONT'D) THE FOLLOWING ADDITIONAL INTEREST (ADDL INSURED) HAS BEEN ADDED TO THE POLICY: CITY OF EDMONDS 121 5TH AVE N EDMONDS WA 98020 ADD AI THE FOLLOWING FORM(S) HAS BEEN ADDED: CG 20 13 12-19 ADDL INS—ST,GOV AGY,SUB,POL SUB —PERM PRM THE FOLLOWING FORM(S) HAS BEEN DELETED: CG 21 41 12-19 EXCL—INTERCOMPANY PRODUCTS SUITS ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME REMOVAL PERMIT If this policy includes the Commercial Property Coverage Part, the following applies with respect to the Cover- age Part: If Covered Property is removed to a new location that is described on this Policy Change, you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of this Policy Change; after that, this insurance does not apply at the previous location. U-GU-614-B CW (10/ 16) POLICY NUMBER: CPO 0236686-02 COMMERCIAL GENERAL LIABILITY CG 20 13 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS RELATING TO PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF EDMONDS 121 5TH AVE N EDMONDS, WA USA 98020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: 1. The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 2. The construction, erection or removal of 1. Required by the contract or agreement; or elevators; or 2. Available under the applicable limits of 3. The ownership, maintenance or use of any insurance; elevators covered by this insurance. whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 13 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1