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/'"""� MOSAI-1 OP ID: Mi <br /> A�ORO�� DATE(MMfDDNYYY) <br /> �...— CERTIFICAT� OF LIABILITY INS[JRANCE �o�os��3 <br /> THIS CERTIFICATE IS ISSU�D AS A MATTER OF INFORMA710N ONLY ANQ COhtFER5 Np RIGHTS UPON ThlE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DdES NOT AFFIf2MATIVELY OF2 T�EGATIVELY AMEND, EXTEND OR ALTER 7HE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. TH1S CERTfFICATE OF INSURANGE DOES NOT CONSTITUTE A CONTRACT BETWE�N THE ISSUlNG INSURER(S), AUTHORIZED <br /> REPRESEN7ATIVE OR PRODUCEI2,AND THE CERTIFICATE HOLDER. <br /> iMPORTANT: If the certificate hotder is an ABDITIONAL INSURED, the policy(ies) must be endorsed. ff SUBROGATiON IS WAIVED,subject to <br /> fhe terms and conditions of the poficy, certain policies may require an endorsement. A statement on Yhis certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Phone:848-246-2800 NAME: <br /> TIB Transportation ins Brokers Fax: 818-246-4690 P��NE — ��F'�A"X <br /> 425 West Broadway,Suite 400 E MAt�.o.Extl: �(A/c No1: <br /> Glendale,CA 91204 ADDRESS: <br /> INSURER(S)AFFOR�ING COVERAGE NAlG# <br /> _ _, �n,suaERa:CAState Compensation lns Fund <br /> ItJSURED RMEX@CU�IV@TC8i1SpOCCBfi011 v INSURERB: r <br /> Inc DBA: Mosaic Giobal — <br /> Transportation INSURER C: <br /> 643 Bair Island Rd#210 �NSURERD: <br /> Redwood City, CA 94Q63 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NtJMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES �F INSURANCE LISTED BEIOW HAVE SEEN ISSUED TO THE INSURED NANIED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. N07WI7HSTANDING ANY REQUIREMEtJT, TERM OR CONDITION OF ANY CQNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PER7AIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDtTIdNS OF SUCH POLICIES. LIMITS SHpWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> I�T� TYPE OF WSURANCE � POUCY NUMBER Mf�74D/YYYY MMlD YYYY LIMI7S <br /> GENERAL LIABILITV EACH OCCURRENCE $ <br /> DAIV�T��`E�Tb��NT�D <br /> COMMERCIAL GENERAL LIABILIN PREMISES Ea occurrence $ <br /> CLAIMS-MADE � OCCUR MED EXP(A�y one person) $ <br /> PERSONAL&ADV IN.IURY $ <br /> GENERALAGGREGATE $ <br /> GEN'L AGGREGATE LIM�T APPLIES PER: PRODUCTS-COMPlOP AGG $ <br /> POLICY PRO- LOC $ <br /> AUTOMOBILE UABILITY COMBINED SINGLE LIMIT <br /> Ea accident $ �_ <br /> ANY AUTO BODILY 1M1lJURY(Per person) $ <br /> ALLOWNED SCHEDULED BObILYINJURY Peraccident $ <br /> AUTOS AUTOS ( 1 <br /> NON-OWNED PROPER tY DAMAGE <br /> HIRED AUTOS AUTOS Per accidentl $ <br /> _ $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS GOMPENSATtON WC STATU- OTM- <br /> AND EMPLOYERS'LIABILITY Y f N X T Y T _ R __�_ _____ <br /> A ANYPROPRIETOR/PARTNERIEXECUTIVE 906647513 07/25J13 07/25I14 E.L.EACNACCIDEN7 $ '�,�40�00� <br /> OFRCERlMEMBER EXCLUDED? � N�A . . <br /> (Mandatary in NH} E.L.DISEASE-EA EMPLOYEE $ �,��0,0�� <br /> If yes,dascribe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ �,QOO,OOO <br /> I <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACbRD t01,Additional Remarks Schedule,ifmore space is required) <br /> Officer exclusion appZies - Ma,ura.ce Brewstar <br /> CERTIFICATE HO�DER CANCELLATION <br /> 0040000 <br /> SHOULD ANY QF TME ABOVE DESCRI8ED POL1ClES BE CANCELLED BEFORE <br /> THE EXPII2ATION DATE THEf2E0F, IVOTICE WILL BE DEUVER�D IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> City of Redwood City <br /> Attll: ECOf}OfT11C DBVeIOp117Ql1t AUTHORIZED REPRESEN7qTIVE <br /> Manager �� <br /> 1017 Midd�efield Road �_ <br /> Redwood Ci CA 94063 <br /> OO 9988-2010 ACORD CORPORATION. AI!rights reserved. <br /> ACORD 25(2010/05) The AGORD name and Eogo are registered marks of ACpRD <br />