Swifty Sweets-Certificate of Insurance-2019.q►co►�n� CERTIFICATE OF LIABILITY INSURANCE
DATE{MM/DDIYYYY)
01/24/2019
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
CONTACT Ilda L. Mitchel
NAME:
Ilda L. Mitchel State Farm Insurance Agency
PHONE t : 408-238-0100 FAX(ain No : 408-238-0106
A 5710 Cahalan Ave., Suite #4Q
cl-y,-; �
E-MAIL
ADDRESS: pyC� rTrlilda.mitchel.rn statefa.com
_
San Jose, CA 95123
INSURE S AFFORDING COVERAGE
NAIC #
INSURERA: State Farm Fire and Casualty Company
25143
INSURED
INSURER B : State Farm Mutual Automobile Insurance Company
25178
S,oAfty Sweets LLC
INSURER C :
421 Ariel Dr.
INSURER D
San Jose, CA 95123-4206
INSURER 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.
—SR
TN
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVQ
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDDIYYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES fEa occurrence
$ 300,000
MED EXP (Any one person)
S 5,000
PERSONAL &ADV INJURY
$ 1,000,000
Y
Y
97-CT-YO72-8
09/07/2016
09/07/2019
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ J8C7 E] LOC
GENERALAGGREGATE
$ 2,000,000
PRODUCTS-COMPIOPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
309 9805-007-05A
09/07/2016
09/07/2019
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$ 1,000,000
ANY AUTO
AUTOS ONLY AUTOSULE❑
BODILY INJURY (Per acc[dent)
$ 1,000,000
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
S 1,000,000
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$ 1,000,000
EXCESS LJAB
CLAIMS -MADE
97-CU-C919-3
01/10/2017
01/10/2020
AGGREGATE
$ 2,000,000
DFD i RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBEREXCLUDED? ❑
NIA
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
Ira, descnbe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
The City of Cupertino and their officers, employees, representatives and agents are named as Additional Insured.
* The Additional Insured endorsement has been submitted and the endorsement page will be mailed directly to the Certificate Holder listed below, please allow
10 business days for processing and mailing, The Additional Insured endorsement has been noted with a "Y" on this ACORD form. *
Cupertino Chamber of Commerce
20455 Silverado Ave
Cupertino, CA 95014
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
D 1988-2015
TION_ All rirthtQ rPCPrverl
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
1001486 132849.12 03-16.2016