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                    PACIFIC NORTHWEST BUSINESS INSURANCE
                         A Berkshire Company

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                         QUARTERLY PREMIUM NOTICE
                              & PAYMENT RECEIPT

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Policy Holder: Basecamp Coffee Roasters LLC
Policy Number: PNBI-COM-789234
Effective Date: January 1, 2025 - December 31, 2025

Mailing Address:
2847 SE Division St
Portland, OR 97202

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COVERAGE SUMMARY
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Commercial Package Policy including:

  General Liability
    - $1,000,000 per occurrence
    - $2,000,000 aggregate

  Property Coverage
    - Building: $250,000
    - Business Personal Property: $75,000
    - Equipment Breakdown included

  Business Income
    - $50,000 limit
    - 30-day waiting period

  Workers Compensation
    - Oregon statutory limits
    - 3 employees covered

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PAYMENT DETAILS
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Coverage Period: Q1 2026 (Jan 1 - Mar 31, 2026)

Quarterly Premium Breakdown:
  General Liability                              $312.50
  Property                                       $187.50
  Business Income                                 $75.00
  Workers Compensation                           $300.00
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  Quarterly Premium:                             $875.00

Payment Received: January 1, 2026
Payment Method: ACH - Checking ****7823
Confirmation #: PNBI-PAY-20260101-4521

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Next Payment Due: April 1, 2026
Amount: $875.00

Questions? Contact your agent:
Sarah Mitchell - sarah.mitchell@pnwbusinessins.com
(503) 555-0445

Claims: 1-800-555-CLAIM (24/7)
Online: www.pnwbusinessinsurance.com

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                    Thank you for choosing PNBI!
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