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ACoR" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDIYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />10/8/2025
<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(ies) 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: Brandie Collier
<br />IMA, Inc. - Pasadena
<br />3475 E. Foothill Boulevard
<br />PHONE FAX
<br />/c No): 626-441-3233
<br />A/c No Ext): 626-799-7000 A/C.
<br />ADDRESS:
<br />Suite 100
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />Pasadena CA 91107
<br />INSURERA: Sentry Insurance Company 24988
<br />License#: 0008309
<br />INSURED COFFHOL-C1
<br />INSURER B: The Hanover American Insurance Company 36064
<br />Coffeebar Holdings, LLC
<br />682 Mt. Rose St
<br />INSURER C:
<br />INSURER D:
<br />Reno NV 89509
<br />INSURER E:
<br />INSURER F,
<br />COVERAGES CERTIFICATE NUMBER: 1978931009 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 />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />A0257721002
<br />7/21/2025
<br />7/21/2026
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $ 500,000
<br />MED EXP (Any one person) $
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 3,000,000
<br />POLICY� JECT PRO � LOC
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />Liquor Liability $ 1,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />A0257721001
<br />7/21/2025
<br />7/21/2026
<br />(CO,$1,000,000
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />OWNED�( SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />A0257721005
<br />7/21/2025
<br />7/21/2026
<br />EACH OCCURRENCE $3,000,000
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 1 n nnn
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />WZ3M062991
<br />7/21/2025
<br />7/21/2026
<br />X PER OTH-
<br />STATUTE ER
<br />EACH ACCIDENT $ 1,000,000
<br />OFFICER/M EMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Redwood City Operations
<br />Certificate Holder includes : City of Redwood City, its council members, officers, boards, commissions, employees and agents.
<br />Certificate Holder and all other parties required by the contract are included as Additional Insured on the General Liability Policy, if required by written contract
<br />or agreement, subject to the policy terms and conditions.
<br />This Insurance is Primary & Non -Contributory on the General Liability Policy, if required by written contract or agreement, subject to the policy terms and
<br />conditions.
<br />A Waiver of Subrogation is provided in favor of Certificate Holder and all other parties required by the contract on the General Liability and Workers
<br />Compensation Policies, if required by written contract or agreement, subject to the policy terms and conditions.
<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.2016.017/Coffeebar Menlo Park, LLC (2020 Broadway) (Page 16 of 28)
<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 />Community Development Department
<br />1017 Middlefield Rd
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. Box 391
<br />Redwood City CA 94064
<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.2016.017/Coffeebar Menlo Park, LLC (2020 Broadway) (Page 16 of 28)
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