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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />05/28/2024
<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 />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. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />A/c NN Ext, (310) 540-8595 'C'No, (310) 540-6554
<br />Daiwa Insurance Marketing, Inc.
<br />E-MAIL
<br />ADDRESS: info@daiwains.com
<br />21515 Hawthorne Blvd. Suite 900
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: Mitsui Sumitomo Insurance Company 20361
<br />Torrance CA 90503
<br />INSURED
<br />INSURER B: Employers Assurance Company 36870
<br />INSURER C:
<br />EK food services Inc / Shabuway Franchising Inc
<br />INSURER D:
<br />PO BOX #195
<br />INSURER E:
<br />205 De Anza Blvd
<br />INSURER F:
<br />San Mateo CA 94402
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />I
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO TED
<br />PREMISES (Ea occurrence) $ 100,000
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />A
<br />Y
<br />Y
<br />PKG3127488
<br />01/20/2024
<br />01/20/2025
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />X JECT POLICY ❑ PRO ❑ LOC
<br />PRODUCTS - COMP/OPAGG $ 2,000,000
<br />Liquor Liability $ 1,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BVR8407162
<br />01/20/2024
<br />01/20/2025
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />A
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />EXS6500191
<br />02/13/2024
<br />01/20/2025
<br />DED I X I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? N
<br />(Mandatory in NH)
<br />N/A
<br />Y
<br />EIG2728420
<br />01/01/2024
<br />01/01/2025
<br />STATUTE ETH
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Redwood City, and its officers, officials, employees, and agents are named as additional insured.
<br />Location Address: 865 Middlefield Rd, Redwood City, CA 94063
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2024.155/EK Food Services Inc (865 Middlefield Rd) (Page 20 of 25)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Redwood City
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />c/o Engineering Division
<br />AUTHORIZED REPRESENTATIVE
<br />1017 Middlefield Rd
<br />Redwood City, CA 94061
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2024.155/EK Food Services Inc (865 Middlefield Rd) (Page 20 of 25)
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