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COVERAGES CERTIFICATE NUMBER: 570112885833 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 INDICATED.
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />FT 77-05/30/2025.1-111-Y)
<br />055
<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
<br />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
<br />holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED,
<br />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 />Aon Risk Services Central,
<br />Phi 1 adel phi a PA Office
<br />Inc.
<br />CONTACT
<br />PHONE FAX
<br />(A/C. No. Ext): (866) 283-7122 Iq/c. Nc.); (800) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />100 North 18th Street
<br />16th Floor
<br />EACH OCCURRENCE $2,000,000
<br />Philadelphia PA 19103 USA
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) $1,000,000
<br />INSURER A: Everest National Insurance Co 10120
<br />Peet's coffee & Tea Holdco,
<br />1400 Park Avenue
<br />Emeryville CA 94608 USA
<br />Inc.
<br />INSURER B: Zurich American Ins Co 16535
<br />INSURER C: Scottsdale Ins Company 41297
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570112885833 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 INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
<br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY
<br />HAVE BEEN REDUCED BY PAID CLAIMS. Limits Shown are as requested
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />EFF
<br />(POLICYMMIDD/YYYY)
<br />POLICY EXP
<br />(MMIDD/YYYY)
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />RM4GL00009241
<br />10/01/2024
<br />10/01/2025
<br />EACH OCCURRENCE $2,000,000
<br />CLAIMS -MADE X OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) $1,000,000
<br />MED EXP (Any one person)
<br />PERSONAL & ADV INJURY $2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />PRO-
<br />POLICY IIL�II � ❑X
<br />JECT LOC
<br />PRODUCTS - COMP/OP AGO $2,000,000
<br />OTHER'
<br />A
<br />AUTOMOBILE LIABILITY
<br />RM4CA00007-241
<br />10/01/2024
<br />10/01/2025
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $2,000,000
<br />Bus Auto Cvg - MA
<br />A
<br />X ANY AUTO
<br />RM4CA00008-241
<br />10/01/2024
<br />10/01/2025
<br />BODILY INJURY( Per person)
<br />BODILY INJURY (Per accident)
<br />OWNED SCHEDULED
<br />Bus Auto Cvg– AOS
<br />AUTOS ONLY AUTOS
<br />PROPERTY DAMAGE
<br />HIRED AUTOS NON -OWNED
<br />(Per accident)
<br />ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />XC5EX02103241
<br />10/01/2024
<br />10/01/2025
<br />EACH OCCURRENCE $10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $10,000,000
<br />DED X RETENTION $10,000
<br />B
<br />WORKERS COMPENSATION AND
<br />wc013677510
<br />10/01/2024
<br />10/01/2025
<br />X PER STATUTEOTRH-
<br />JE
<br />EMPLOYERS' LIABILITY YIN
<br />Workers Comp- (MA, WI)
<br />E.L. EACH ACCIDENT $1,000,000
<br />B
<br />ANY PROPRIETOR / PARTNER/ EXECUTIVE
<br />OFFICERMEMBEREXCLUDED? IN
<br />NIA
<br />WC013677410
<br />10/01/2024
<br />10/01/2025
<br />E.L. DISEASE -EA EMPLOYEE $1,000,000
<br />(Mandatory in NH)
<br />workers Comp- (AOS)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />c
<br />Product Recall
<br />RBs0327417
<br />10/01/2024
<br />10/01/2025
<br />Aggregate Limit $15,000,000
<br />SIR applies per policy ter
<br />Tis & condi
<br />ions
<br />SIR $500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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
<br />officers, officials, employees and agents are included as Additional Insured in accordance with the policy provisions of the
<br />General Liability policy. General Liability policy evidenced herein is Primary and Non -Contributory to other insurance
<br />available to Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in
<br />favor of The City of Redwood City and its officers, officials, employees and agents in accordance with the policy provisions o
<br />the General Liability and workers' Compensation policies.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />The City of Redwood City AUTHORIZED REPRESENTATIVE
<br />c/o Engineering
<br />1017 Middlefield Road
<br />Redwood City CA 940614061 USA
<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.2025.204/Peet's Coffee (2600 Broadway) (Page 18 of 32)
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