Agmt26 Dasbierhauz (830 Middlefield Road)

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AC�Rl7® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/04/2025 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 A B C Insurance 3401 Pacific Blvd., CONTACT CL 2 - MELODY CHIEN NAME: (A/C, No. Ext): (650) 357-9077 PHONE FAX No): 650-357-9078 E-MAIL San Mateo CA 94403 11/01/26 ADDRESS INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $ 5,000 INSURER A: State National Insurance Agency Lic#: OD08437 INSURED INSURER B: FIRST COMPENSATION DASBIERHAUZ C/O DASBI LLC INSURER C: INSURER D: 830 MIDDLEFIELD ROAD INSURER E: REDWOOD CITY CA 94063 INSURER F: COVERAGES CERTIFICATE NUMBER: 39615 REVISION NUMBER:1 SUPERCEDES PREVIOUS REVISIONS 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 ADDL INSRD SUBR WVD POLICY NUMBER POLICY EFF DATE (MM/DDIYY) POLICY EXP DATE (MM/DDM') LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE[j] OCCUR X LIQUOR LIABILITY X X NXTDDXLT7R-01-GL 11/01/25 11/01/26 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 PREMISES Ea occurence MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY EJ PRO JECT ❑LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,N000 LIQUOR LIABILITY $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLYAUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Y If yes, describe under DESCRIPTION OF OPERATIONS below N/A X MWCO226894-02 06/03/25 06/03/26 X PER OTH- STAT TE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See Attached Supplement CERTIFICATE HOLDER CANCELLATION The City of Redwood City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1017 Middlefield Road ACCORDANCE WITH THE POLICY PROVISIONS. Redwood City CA 94061 Attention: Neil C. Hsu Lic # 0790049 ACORD 25 (2016/03) Certificate # 39615 Revision # 1 © 1988-2015 ACORD CORPORATION. All right reserved. The ACORD name and logo are registered marks of ACORD ATTY/AGR.2026.035/DASBI LLC (830 Middlefield Rd) (Page 16 of 54)