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We Sushi-Certificate of Insurance-2013DATE AC" �° CERTIFICATE OF LIABILITY INSURANCE 03/(26� 013 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(les) 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 endorsements). PRODUCER CONTACT NAME DOLORES VILLANUEVA RVIS INSURANCE AGENCY PHONE 406-928-5960 FAX N408-928-5965 LAIC, Nu. Ell -- 1 tA/C• 8 1670 BERRYESSA RD E-MAIL _ADDRESS - TYC00N62QAOL.CON -- -- ------- SAN JOSE , CA 95133 PRODUCER INSURER(s) AFFORDING COVERAGE INSURED INsuaeR A BURLINGTON INSURANCE CO. RODA APT, LLC 2842 CLEMENT ST SAN FRANCISCO, CA 94121 INSURER C INSURER INSURER E: INSURER F w,w�n win nnnt�r,r aTa su rueco. RFVISInNtNIIMRFR[ 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDIYYYY MMIDDlYYW LIMITS LTR GENERAL LIABILITY COMMERCIALGENERAL LIABILITY 846B001654 02/10/2013 02/10/2014 EACH OCCURRENCE $ 1,000,000 ---- - $ 100,000 PREMISES EaEoccurrence MED EXP (Any one person) $ 5,000 CLAIMS -MADE ] OCCUR PERSONAL &ADV INJURY $ 1,000,000 A Y GENERAL AGGREGATE 3 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 $ — 1/1 POLICY PRO- LOG AUTOMOBILE LIABILITY 08331238-1 11/22/2012 11/22/2013' COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) E ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED AUTOS B SCHEDULEDAUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) S E — NON -OWNED AUTOS E UMBRELLA LIAR EACH OCCURRENCE E AGGREGATE $ HOCCUR EXCESS Li CLAIMS -MADE DEDUCTIBLE $ WC STATU- OTH- $ RETENTION $ WORKERS COMPENSATION E L EACH ACCIDENT 1 $ AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E L DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) NIA E L DISEASE - POLICY LIMIT 1 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) CERTIFICATE HOLDER AND THE CITY OF CUPERTINO AND THEIR OFFICERS, EMPLOYEES, REPRESENTATIVES AND AGENTS ARE NAND AS ADDITIONAL INSURED PER FORM BG-G-305 AUTOMATIC ADDITIONAL INSURED ON GENERAL LIABILITY POLICY. CERTIFICATE MULUEK CUPERTINO CITY HALL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10300 TORRB AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CUPERTINO, CA 95014 AUTHO D REPRESENTATIVE II elv.,�t,-"" ©198R.2nn9 ACORn CCRPORATICN_ All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD