Agmt25 Blacksmith (2048 Broadway)

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COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY DATE (MM/DD/YYYY) .ICOR CERTIFICATE OF LIABILITY INSURANCE INSR LTR TYPE OF INSURANCE 06/17/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s). X COMMERCIAL GENERAL LIABILITY CONTACT NAME: PRODUCER PHONE FAX Bruce Lyons (A/C, No, Ext): 415-472-1800 (A/C, No): Coastal Pacific Insurance Marketing LLC E-MAIL 77 Mark Dr #24 San Rafael CA 94903 ADDRESS: bruce@coastalpacificins.com INSURERS) AFFORDING COVERAGE NAIC # DAMAGE TO RENTED PREMISES (Ea $100,000 occurrence) INSURER A: Berkshire Hathaway Direct Insurance Company 10391 INSURER B :EMPLOYERS PREFERRED INSURANCE COMPANY INSURED INSURER C: Barrel Dog, Inc. dba Blacksmith INSURER D: 138 Loma Vista Dr INSURER E: Burlingame CA 94010 INSURER F: 06/22/2025 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSO SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP MMID LIMrTS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X X CLAIMS -MADE I X OCCUR DAMAGE TO RENTED PREMISES (Ea $100,000 occurrence) MED EXP (Any one person) $5,000 A PCA602577E 06/22/2025 06/22/2026 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY PRO- LOC JECT PRODUCTS-COMP/OP AGG $3,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO X X BODILY INJURY (Per person) $ PCA602577E 06/22/2025 06/22/2026 OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY (Per accident) $ X HIREDAUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ HIRED AND NON -OWNED $1,000,000/ $3,000,000 UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION ANDPER EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N/A X EIG 550498001 02/21/2025 02/21/2026 X STATUTE OTHER $ 1 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE- EA EMPLOYEE $1,000,000 (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 OCCUR X X $1,000,000 / PER OCCUR/AGGREGATE $3,000,000 Errors & Omissions X A PCA602577E 06/22/2025 06/22/2026 CYBER X PEROCCUR/AGGREGATE $1,000,000/ $3,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Redwood City and its Council, officers, officials, agents, employees, and volurdcers. are an additional insured on the general liability policy only in regard to work pertommed by the insured, per ISO endorsements CG 20 37 0413 and CG 2010 04 13 and CG 20 0104 13 and CG 2012 05 09 and CG 20 29 or equivalent The policy contains a blanket Additional Insured provision adding Additional Insured where required by a written contract with the insured prior to the start of work The certificate holder is named an additional insured. Waiver of Subrogation and Blanket Additional Insured provisions are contained with Form 3PG 00 OD -1 112 2. The insurer agrees to waive our right to recover from the certificate holder to the extent required by written centracL The certificate holder has waivers of subrogation as their interest may appear (ATIMA)_ The policy contains a blanket waiver of subrogation where required by a written contract with the insured prior to the start of work performed by insured, per ISO endorsements CG 20 10 11 85 and or equivalent The policy is Primary as to the losses it covers, and the insurer will not seek contribution I there is a written contract requirement between the insured and the certificate holder. Completed and Ongoing operations regarding general liability are included subject to the Each Occurrence and General Aggregate in the Commercial General Liability section for policy tPCA602577E- The insurer will provide at least 75 days before cancellation or 75 days 8 for nonpayment of premum prior to when the insurer cancels and non -renews. Liquor Liability coverage is included at $1,000,000 and $3,000,000 for policy number PCA602577E effective date 06/22/24-062225. CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. ATTY/AGR.2025.229/Barrel Dog, Inc. dba Blacksmith (2048 Broadway - Blacksmith) (Page 17 of 44) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Redwood City ACCORDANCE WITH THE POLICY PROVISIONS. 1017 Middlefield Rd AUTHORIZED REPRESENTATIVE Redwood City, CA 94063 © 1988-2015 ACORD CORPORATION. All rights reserved. ATTY/AGR.2025.229/Barrel Dog, Inc. dba Blacksmith (2048 Broadway - Blacksmith) (Page 17 of 44)