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HILLMYH-U1
<br />MINCLLYMtLtNUtL
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/YYYY)
<br />9/19/2024
<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 />NFP Property & Casualty Services, Inc.
<br />160 West Santa Clara Street
<br />Suite 575
<br />San Jose, CA 95113
<br />PHONE FAX
<br />(A/C, No, Ext): (408) 792-5400 (AIC, No):(408) 792-3670
<br />ADDRIE :
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: Travelers Property Casualty Company of America 25674
<br />INSURED
<br />INSURER B: General Star Indemnity Company 37362J
<br />INSURER C:Republic Indemnity Company of America 22179
<br />Pizza My Heart Inc
<br />Chuck Hammers
<br />X
<br />16222 Shannon Rd
<br />INSURER D:
<br />INSURER E:
<br />Los Gatos, CA 95032
<br />INSURER F:
<br />DAMAGE TO RENTED 300,000
<br />PREMISES Ea occurrence $
<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 />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE X OCCUR6301W704459
<br />X
<br />1/21/2024
<br />1/21/2025
<br />DAMAGE TO RENTED 300,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any oneperson) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />X POLICY JECOT- F—]LOC
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />LIQUOR LIABILIT $ 1,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,000
<br />Ea accident $
<br />BODILY INJURY Per personi—
<br />ANY AUTO
<br />IXG425869E
<br />1/21/2024
<br />1/21/2025
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident $
<br />PROPERTY
<br />accidentDAMAGE $
<br />X
<br />AUTOS ONLY X AUUTOS ONLIY
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $ 5,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />EX -5X504516
<br />1/21/2024
<br />1/21/2025
<br />DED I X I RETENTION $ 0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/ PARTNER/EXECUTIVE ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />15756023
<br />1/21/2024
<br />1/21/2025
<br />X PER OTH-
<br />STATUTE ER
<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, may be attached if more space is required)
<br />RE: Per written contract or agreement with the Named Insured.
<br />The City of Redwood City, its Council, officers, officials, agents, employees, and volunteers are named as Additional Insured as respects to General Liability
<br />per form CG D4 67 02 19 attached. General Liability Primary & Non-contributory applies per form CG T1 00 02 19 attached. General Liability Waiver of
<br />Subrogation applies per form CG D4 67 02 19 attached.
<br />Workers Compensation Waiver of Subrogation apples per Endorsement WC 00 03 13 attached.
<br />Form CIR attached.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2024.204/Pizza My Heart (831 Middlefield Rd) (Page 20 of 29)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The Cit of Redwood Cit
<br />Y Y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />C/o Engineering Division
<br />1017 Middlefield Road
<br />AUTHORIZED REPRESENTATIVE
<br />Redwood City, CA 94061
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2024.204/Pizza My Heart (831 Middlefield Rd) (Page 20 of 29)
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