Curry Up Now-Certificate of Insurance-2012,4c=oRr'�® CERTIFICATE OF LIABILITY INSURANCE
-DATE DlYYYY)
�.�
03/29/2129I2012
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 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
CONTACT
NAME: ALLSTATE INSURANCE COMPANY
PHONE Fax
NORTHEAST AGENCY INSURANCE SERVICES
No Ezt : AIC Na
E-MAIL
2495 MAIN STREET SUITE 209
ADDRESS:
INSURER ($) AFFORDING COVERAGE
NA]C #
BUFFALO, NY 14214
INSURERA: NAUTILUS INSURANCE COMPANY TAPCO
524210
INSURED
JARDEEP KAPOOR DBA CURRY UP NOW
INSURER B :
35 STONEPINE ROAD
INSURERC:
BURLINGAME CA 94010
INSURERD:
ENSURER E :
INSURER F :
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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDD
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,G00,000.00
X COMMERCIAL GENERAL LIABILITY
DAMA E T REN D
PREMISES Ea occurrence
$ 50 000.00
CLAIMS -MADE X OCCUR
F.
17
MED EXP (Any one person)
$ 5 00G.00
SADVINJURY
$ 1,000,000.00
NN111330 FZBY-G
02/26/2012
02/26/2013
-PERSONAL
GENERAL AGGREGATE
$ 2,000,000.00
GEN'LAGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOPAGG
$1000 000.00
$
POLICY PRO JECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
peraecideni
$
NON -OWNED
HIREDAUTOS AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
WC STATU- OTH-
TORY LIMIT FR
E.L. EACH ACCIDENT
$
OFFICEIMEMBER EXCLUDED? ❑
NIA
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYE
$
If yes, describe under
r)rqQ.RIPT1QN OF OPERATIONS beloW
E.L. DISEASE - POLICYLIM IT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
ADDITIONAL NAMED INSURED
THE CITY OF CUPERTINO AND THEIR OFFICERS, EMPLOYEES, REPRESENTATIVES, VOLUNTEERS, AND AGENTS.
CERTIFICATE HOLDER CANCKLATION
CUPERTINO CITY HALL
ABO DESCRIBED POLICIES BE C NCELLED BEFORE
HOULD ANY OF TH!ATE
THE EXP HEREOF, NOTICE WILL B DELIVERED EN
10340 TORRE AVE
ACC0 NCE WITHTHE PO ICY PRO IONS.
CUPERTINO, CA 95014
AUTH RIZED REPRESE
f
01988�7010-ACORD=RAQBATION. AIWwjhts.xeserared.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD