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ACORO® CERTIFICATE OF LIABILITY INSURANCE 3/30/2024
<br />1
<br />DATE(MM/DD/YYYY)
<br />9/28/2023
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />SUBR
<br />WVD
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.
<br />A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />A
<br />PRODUCER IAckton Companies
<br />8110 E Union Avenue
<br />Suite 100
<br />Denver CO 80237
<br />CONTACT
<br />NAME:
<br />N
<br />PHONE FAX
<br />A/C No
<br />Ext):(AIC,
<br />10/1/2023
<br />E-MAILo
<br />ADDRESS:
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />(303) 414-6000
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Everest Premier Insurance Company
<br />16045
<br />INSURED Peet's Coffee & Tea HoldCo, Inc.
<br />1416918 1400 Park Avenue
<br />INSURER B : Everest National Insurance Company
<br />10120
<br />INSURER C : American Zurich Insurance Company
<br />40142
<br />INSURER D : Zurich American Insurance Company
<br />16535
<br />Emeryville, CA 94608
<br />INSURER E : Scottsdale Insurance Company
<br />41297
<br />INSURER F :
<br />PERSONAL & ADV INJURY
<br />COVERAGES CERTIFICATE NUMBER: 18890941 REVISION NUMBER: XXXXXXX
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y'
<br />N
<br />RM8GL00030231
<br />10/1/2023
<br />10/1/2024
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000 000 000
<br />MED EXP (Any one person)
<br />$ XXXXXXX
<br />X SIR: $350,000
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 10,000,000
<br />X POLICYjE N LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />N
<br />N
<br />RM8CA00036-231 AOS)
<br />RM8CA00037-231 AVIA)
<br />10/1/2023
<br />10/1/2023
<br />10/1/2024
<br />10/1/2024
<br />(CEO, acc d.n'SINGLE LIMIT
<br />$ 2,000,000
<br />BODILY INJURY (Per person)
<br />$ XXXXXXX
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$ XXXXXXX
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ XX=xx
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Deductible
<br />$ 25,000
<br />X
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />N
<br />N
<br />XC2EX00149-231
<br />10/1/2023
<br />10/1/2024
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X I RETENTION $ 10,000
<br />$ XXXXXXX
<br />C
<br />D
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? F_N]
<br />(Mandatory in NH)
<br />N / A
<br />Y
<br />WC 0136774 09 (AOS)
<br />WC 0136775 09 (MA, WI)
<br />10/1/2023
<br />10/1/2023
<br />10/1/2024
<br />10/1/2024
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />E
<br />Product Recall
<br />N
<br />N
<br />RBS0070098
<br />3/30/2023
<br />3/30/2024
<br />Any One Insured Event: $15M
<br />Aggregate: $15M
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: #1107 Redwood City - 2600 Broadway, Redwood City, CA 94063 for Sidewalk Permit. The City of Redwood City, and its officers, officials, employees, and agents are
<br />included as Additional Insured as respects General Liability if required by written contract. Waiver of Subrogation applies in favor of the Additional Insured as respects
<br />Workers Compensation if required by written contract, where permissible by law.
<br />CERTIFICATE HOLDER CANCELLATION See Attachment
<br />18890941
<br />The City of Redwood City
<br />c/o Engineering
<br />1017 Middlefield Road
<br />Redwood City CA 94061
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENT
<br />(C", 1 gFIR -2
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2024.067/Peet's Coffee (2600 Broadway) (Page 20 of 23)
<br />TION_ All riahtc rpsprvpd
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