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HomeMy WebLinkAboutBLDCI-22-002925 The Commonwealth of Massachusetts City\Town of YARMOUTH New and Renewal Certificate of Inspection In accordance with 780 CMR, Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to Business Name:Alpha Entertainment Group, LLC BLDCI-22-002925 Trade Name:The Music Room Identify property address including street number, name,city or town and county Certificate Expiration Located at 517 ROUTE 28 12/31/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 88 A-2 Nightclub/Restaurant/Bar/Banquet Hall Allowable Occupant Load This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Philip Simonian III Name of Municipal _ Mark Grylls Date of ��_���' Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal � / Date of Fire Chief , wilding Commissioner , 61(� Issuance /2 • • 2 Fee: $150.00 BLDCertoflnspection.rpt BUILDING NG DEPARTMENT MEN 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2022 NAME: Music Room ADDRESS: 517 RTE 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Date Comments Approved for License Issuance es No Fire Department Rep. Date Comments Approved for /4— G"-- Li se Issuance 7 ' Ye No , C` A i \ OCR. Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for /Z 7y(z K License Issuance LYE No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 •°� YaR TOWN OF YARMOUTH • r; l. ip�a o �, BUILDING DEPARTMENT "„T,: „ s �i 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 O :+:tray Y9� / ) 82 ' PLICAT N F 7 1 - iZ4.1Li OR CERTIFICATE OF INSPECTION November 17, 2021 PAYABLE U (X) Fee Req ' ed 150.00 ( )No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: < / 7 9 ?g - /VI'7/C ,�.v ,s(1/ >. Name of Premises: j / - v,j'i L on.. Tel: 4'/ -7) d'Z/ - /2 o y Purpose for which permit is used: c 47,.,,,ti, ,1--4 c 5,,✓f'e- -� Eti c,, N Mrt.J .4(c E.-✓f 6 License(s) or Permit(s)required for the premises by other governmental agencies: 6( 5I/,,,6„—r6 License or Permit Agency 17vic /), a f i 4 /1°'':1`j Certificate to be issued to nt/h,t 6-i6-C--tea.'✓ --'l G-+o ../y L c Tel:�t 7 8? ( -/Z o Y Address: si 7 ,,�m 27 / " Owner of Record of Building /A/ c i L4/tJ / L L G. Address it Present Holt : of Certificate ?.�,,A.,., ,��„,,Aa E 1 ' C RECEIVED ri Si j1 re of p oser n to whom Title i NOV 1 2021 Ce ificate is issued or his agent 1(( \ -t i z BUI 1 P RT ENT Date E3Y _ Email Address: g n,( 4 t--( 'fJ G\4, S ,c;, :;M('q p6 Cd ,.c ,vt. Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten(10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection#,}LLC 1 - — 0( 90.j I-P 12/31/21-12/31/22 ,.1I--41 QD DATE(MMIDDIYYYY) AORL' CERTIFICATE OF LIABILITY INSURANCE 11/17/21 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 ACT- NAME: PAUL SCHLEGEL PHONE Schlegel&Schlegel Ins Brokers,Inc. A-MA/CA.No,Ex0. 508-771-8381 FAX No); 508-771-0663 34 Main Street IL • West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: TRISURA SPECIALTY INSURANCE CO INSURED INSURER 8: ALPHA ENTERTAINMENT GROUP LLC INSURER C: DBA MUSIC ROOM INSURER D: 541 MAIN ST ROUTE 28 - WEST YARMOUTH,MA 02673 INSURER E: 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. TFIW ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 i LID CLAIMS-MADE n OCCUR PREM SES EaE occurrence) $ 100,000 MED EXP(Any one person) $ EX A OSU1003029-00 04/30/21 04/30/22 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ _ OTHER: A&B $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS_ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N I A ALWC234457 07/23/21 07/23/22 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under _DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 EACH CAUSE 1,000,000 LIQUOR LIABILITY A OSU1003029 04/30/21 04/30/22 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. 1146 ROUTE 28 SOUTH YARMOUTH,MA 02664 AUTHORIZED REPRESS I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD •Y• R TOWN OF YARMOUTH Building Department CERTIFICATE OF O (508) 398-2231 ext.1261 OCCUPANCY p�"„ y PERMIT NO BLD-20-004118 MATT r Robert-Dunphy ADDRESS 517 ROUTE 28,WEST YARMOUTH, MA 02673 ZONING DISTRICT B2 Bldg.Type:1 Commercial SUBDIVISION MAP BLOCK 031.138.1 REMARKS Alteration per approved plan 780 CMR MSBC 9t Edition-Unit 541 I Room. CERTIFICATE OF INSPECT • / 1.0„.4-<,4•40.10DATE: 2/42021 BUILDING OFFICI .i/ /i �`/ mirm..10 1Michelyn LLC 1 349 Main Street BUILDING DEPT BY Hyannis, Ma 02601 PHONE -HS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR RMANENTLY.ENCROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JRISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF JBLIC WORKS. CERTIFICATE OF OCCUPANCY BUILDING INSPECTIONS APPROVALS FIRE: _APT. OTHER DATE: 2.23. 2 ' DATE: ELECTRICAL BOARD OF HEALTH DATE: Zz"� DATE: 2 2-4 2°2- INSPECTOR: INSPECTOR: PLUMBING/GAS FINAL BUILDING DATE: /6/2rAt} DATE: _a 5 Z r INSPECTOR: Cr-S INSPECTOR: COMMUNITY DEVELOPMENT: DATE NAME F u F ' „ k . a 2 i ' 1 1 ; gi SE: :: :1111 i:1:5- 3 ° --.'-: .:, '... Iii -- 52ie JU 11 'lift ; lIal oil i ; 1:. . . - co al i i i; . 1 Ili: ...;: lit;, , . - .- 2 - k ,.. -- -. .k_-...... . p z is `. . e': iti _k g g 1 y`k ''1 !vigil! 4 • - Ui 4 - ? h : ; tit : .H. 111 -I - - ; lift 8 s• l Iii 8 a gal : § ill :=17.1111 1 ii gli 11 N. ' 0- - - - :t'-',.--i-Pe* - ` II 10.1: I, i Egfb gR4i.,f, z ,, - - Z "- I Ill:::;. •. r "� jJ .. is , 1 i��i•, ! !1IJ � QK i • .. - t+ it r. 04:31 TOWN OF YARMOUTHBuilding DepartmentBUILDING (508)398-2231 ext.1261 PERMIT PERMITNO •BLD-20-004118 41 NI i ISSUE DATE 02/10/2020 JOB WEATHER CARD APPLICANT �ROBERT DUNPHY 1 PERMIT TO , Alteration • AT(LOCATION) 517 ROUTE 28,WEST YARMOUTH,MA 02673 ZONING DISTRICT 182 I Bldg.Type: Commercial . SUBDIVISION MAP BLOCK LOT 031.138.1 BUILDING IS TO BE: CONST TYPE USE GROUP REMARKS Alterations per approved plan 780 CMR MSBC,9th Edition-(Unit 541 Music CONTRACTOR Room)-tenant interior fit out as per plans dated 02106/2020. (781-718-0881) LICENSE 069294 Construction Supervisor DUBLIN CONSTRUCTION ROBERT DUNPHY 3 AREA(SQ FT) 5,426,791,921 EST COST($) 118000.00 _I PERMIT FEE($) 925.00 SOUTH YAR HILL RUN SOUTH YARMOUTH, MA 02664 OWNER MICHELYN LW 1 BUILDING DEPT BY ADDRESS ,349 MAIN STREET 1 HYANNIS 02601 PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILI OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROA THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK:1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL MEMBERS(READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND COVERING)3)FINAL INSPECTION BEFORE REQUIRED,SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4)REFER TO DETAILED INSPECTION BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS Rough Frame Frame Frame Inspector Date Inspector Date Inspector Date Frame Insulation Insulation Inspector Date Inspector Date Inspector Date Building Final Inspector Date WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION NOTED ABOVE. The Commonwealth of Massachusetts _ City\Town of YARMOUTH - !88 T — New and Renewal Certificate of Inspection In accordance with 780 CMR,Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to Business Name:Alpha Entertainment Group, LLC BLDCI-22-002925 Trade Name:The Music Room Identify property address including street number,name,city or town and county Certificate Expiration Located at 517 ROUTE 28 12/31/2022 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other - - C assifications(s) A-2 01st Floor 88 A-2 Nightclub/Restaurant/Bar/Banquet Hall Allowable Occupant Load This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark Grylls Date of s� Fire Chief 0 s � Building Commissioner Inspection /i . 5 _ Signature of Municipal Signature of Municipal ` Date of Fire Chief L ee:Building Commissioner Issuance /z 1 i z $150.00 B LD_Ce rtofl n spectio n.rpt BUILDING DEPARTMENT 1146 Route 28, South learnnouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 LICENSE INSPECTION APPROVAL LOG - 2023 NAME: Music Room ADDRESS: 715 Route 28 This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your building/premises. When all signatures are obtained, this log shall be presented to the License & Permits office and/or the Health Department in order to obtain your license. Licenses will be withheld until all inspectors have signed. Building Commissioner Rep. Date Comments Approved for License Issuance /17/A /6-20-- No Fire Department Rep. Date Comments Approved for Lic a Issuance 4 144- I _ b - ZZ Ye� No Board of Health Rep. Date Comments Approved for License Issuance Yes No Plumbing/Gas Inspector Date Comments Approved for License Issuance Yes No Electrical Inspector Date Comments Approved for License Issuance Yes No Taxes Paid Yes No Rev.Sept.2003 i v„ o" : y BUILDING DEPARTMENT � 1� ` 1146 Route 28, South Yarmouth, MA 02664 508-398-2 : 4ts 2 0i V E D APPLICATION FOR CERTIFICATE OF INSPECTION NOV 212022 UILDING DEPARTMENT November 14, 2022 PAYABLE U'€iLBEGELPT(X) Fee Required 150.00 ( )No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: _y/ /Zo vit Zf Ale c yam••, Name of Premises: Pi MvJ/C Aac)41 Tel: 6') 6/7 - Purpose for which permit is used: i C CN ft" tNfr.1,42 ( i'_'va L) License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency lt-t'7r )1 )Ao Certificate to be issued to CI49 t --7 ,N01,- - C.to Tel (A) G/7 -8 2 / -/2ti/ Address: . // / ..( 2.0 Gv T C yr.+•+s �sr - M4 c' 67r Owner of Record of Building /)1/ 4t .-v,J Lc- . Address PO aa' 2/Z 8 J 3vp %h.t.•✓ c�' ,/TS' ,�i,f ,4 e7 L 'o / P o e ertificate /�j,1/a �..� .-�T-,v�,v n� � uo Okrn/t<-L. Sign re of person to whom Title Certificate is issued or his agent ///7/2- Date Email Address: , ,,ep‘/ Al- c ,z1 6' i'=e v 1, C ../vt. Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth, MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten(10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANN T SUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# g1C�_23-O[D -/3 12/31/2022 to 12/1/2023 ��_- `- ' ' ' _-'~/ ' ` - - ` ` ` ' - `� - _ -__~- / ' ��'' ��`` � .�` ` � �� `� - - " � ', . - . ` - - ' - ' - `' . - o``o . ' . ` . ' -' � ` '`� ^� � � ` � . � � �` ' \ > ' ^-~� � )`) ^l^ / '/ / / ' \ -1 } '�-~ �r~ ~, i ` ' i � / �^, / ~ ` DATE(MMIDDIYYYY) ACURDP CERTIFICATE OF LIABILITY INSURANCE 11/18/22 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 WANED,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 NAME: PAUL SCHLEGEL FAX Schlegel&Schlegel Ins Brokers,Inc. �rcDN lA Ent: 508-771-8381 508-771-0663 34 Main Street E-Miu u West Yarmouth,MA 02673 >nr+FAS: schiegelinsurarrce@gmail.com INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A: TRISURA SPECIALTY INSURANCE CO INSURED INSURER B: GUARD INSURANCE ALPHA ENTERTAINMENT GROUP LLC INSURER C: DBA MUSIC ROOM INSURER o. 541 MAIN ST ROUTE 28 WEST YARMOUTH,MA 02673 NsuRER E: 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 TYPE OF NSURANCE A -BI POLICY EFF POLICY EXP MD WVD POLICY NUMBER J ODDIYYYV) narnorrivn LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE j 1,000,000 CLAIMS-MADE X OCCUR OIWAHETORENTED PREMISES(Ea commence) $ 100,000 MED DIP(My one person) $ EX A - OSU1003029-00 04/30/22 04/30/23 PERSONAL&ADVINJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: ORAL AGGREGATE $ 2,000,000 POLICY LOC PRODUCTS-COMPIOPAGG $ 2,000,090 OTHER: A&B $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT j ANY AUTO (Eaa accident) BODILY INJURY or person) $ OWNED -SCHEDULED AUTOS ONLY AUTOS BOOILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) j $ UMBRELLA LIAR OCCUR • . EXCESS LIAR : EACH OCCU j CLAIMS-MADE AGGREGATE DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I I ER TW ANY PROPRIETORIPARTNERID(ECUTIVE OFFICER/MEMBER EXCLUDED? N I A ALWC304838 11121122 11M/23 : EL EACH ACCIDENT 500,000 (Mandatory In NH) EL IYRFASF-EA EMPLOYEE$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISFeSF-POLICY UNIT $ 500,000 LIQUOR LIABILITY EACH CAUSE 1,000,000 A OSU1003029 I 04/3022 04/30/23 AGGREGATE 1,000,000 DESCRPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF YARMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. 1146 ROUTE 28 SOUTH YARMOUTH,MA 02664 AUTHOR¢®REPRESENTATIVE I V ©1988-201 0 CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD