|
A� L® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />F12/09/2025
<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 />McGriff, a Marsh & McLennan Agency LLC Company
<br />9 Y P Y
<br />5080 Spectrum Dr., Suite 900E(A/C,No
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />Ext): 469-232-2100 A/C No
<br />E-MAIL
<br />ADDRESS:
<br />Addison, TX 75001
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A:Safety National Casualty Corporation 15105
<br />10/01/2025
<br />INSURED
<br />Chipotle Mexican Grill, Inc.
<br />INSURER B:
<br />Chipotle Mexican Grill of Colorado, LLC
<br />INSURER C
<br />610 Newport Center Drive
<br />Newport Beach, CA 92660
<br />INSURER D
<br />INSURER E
<br />INSURER F:
<br />MED EXP (Any one person) $
<br />COVERAGES CERTIFICATE NUMBER:4EMRWHWQ 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/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />GL4047266
<br />10/01/2025
<br />10/01/2026
<br />EACH OCCURRENCE $ 5,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence $ 1,000,000
<br />MED EXP (Any one person) $
<br />X Liquor Liab $5M Each Occ/Aggregate
<br />PERSONAL & ADV INJURY $ 5,000,000
<br />X Location Aggregate $5M
<br />X
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 5,000,000
<br />POLICY ❑PRO FX LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG $ 10,000,000
<br />Policy Max General Agg: $ 25,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />CA6676043
<br />10/01/2025
<br />10/01/2026
<br />COMBINED SINGLE LIMIT 1,000,000
<br />Ea accident $
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY(per.,
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />XUM4068996
<br />10/01/2025
<br />10/01/2026
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE $ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? a
<br />(Mandatory in NH)
<br />N / A
<br />LDS4047264 (AIDS)
<br />PS4047265 (WI)
<br />SP4067312 (Excess OH)
<br />10/01/2025
<br />10/01/2026
<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 />Coverage extends to outdoor dining or patio area if applicable.
<br />Additional Insured by Contract or Agreement — Primary Basis as required by written contract or agreement as respects General Liability.
<br />Store #: 430
<br />Location Address: 861 Middlefield Rd, Redwood City, CA 94063-1627
<br />CERTIFICATE HOLDER CANCELLATION
<br />Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) �hg A6 0367C�ia ones d loo C e i t redd r�� o qC RD
<br />ATTY/AG .L02 p ewca l G�rll� In� f891 Middlefiel d) ( age 17 of 28)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Redwood City
<br />AUTHORIZED REPRESENTATIVE
<br />Engineering & Construction
<br />P.O. Box 391
<br />Redwood City, CA 94064
<br />Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) �hg A6 0367C�ia ones d loo C e i t redd r�� o qC RD
<br />ATTY/AG .L02 p ewca l G�rll� In� f891 Middlefiel d) ( age 17 of 28)
<br />
|