Agmt25 Rockn Wraps (2053 Broadway)

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AC� "® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 08/01/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER StateFarm Kelly Lux � � 2221 Harbor Bay Pkwy CONTACT Kell Lux NAME: y PA//CNNo Ext): 510-521-1222 A/C No): E-MADDRESS: kelly.lux.gjcg@statefarm.com X COMMERCIAL GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : State Farm General Insurance Company 25151 Alameda CA 94502 INSURED INSURER B: INSURER C : Ahmad, All INSURER D: MED EXP (Any one person) $ 5,000 3639 HAVEN AVE UNIT 8331 INSURER E INSURER 1: MENLO PARK CA 940251577 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 PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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 ADD INSD SUB WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS REDWOOD CITY CA 94064-0391 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _7RENTECLAIMS-MADE � OCCUR DAMAGE TO PREMISES (E. occur ante)$ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 A Y Y 97 -CG -W309-9 12/05/2024 12/05/2025 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO - ❑ PRO- FX JECTLOG PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE N/A 97-EO-NO77-2 11/07/2024 11/07/2025 DED I X I RETENTION $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? El PER OTH- TAT TE ER $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) For the location: 2053 Broadway B, Redwood City, CA 94063 City and its Council, officers, officials, agents, employees, and volunteers shall be additional insured including completed operations, primary noncontributory, waiver of rights/recovery; and Worker's Comp Waiver of Subrogation endorsement in favor of City, its Council, officers, agents, employees, and volunteers. CERTIFICATE HOLDER CANCELLATION @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023 ATTY/AGR.2025.296/Rockn Wraps (2053 Broadway) (Page 17 of 36) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF REDWOOD CITY ITS COUNCIL, BOARDS, COMMISIC ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 391 AUTHORIZED REPRESENTATIVE REDWOOD CITY CA 94064-0391 This form was system -generated on 08/01/2025 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023 ATTY/AGR.2025.296/Rockn Wraps (2053 Broadway) (Page 17 of 36)