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DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjectto <br />thetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe <br />certificate holder in lieu of such endorsement(s). <br />CONTACT <br />PRODUCER <br />NAME: <br />FAX <br />PHONE <br />(A/C, No): <br />(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />INSURER A : <br />INSURED <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDLSUBR <br />INSRPOLICY EFFPOLICY EXP <br />TYPE OF INSURANCELIMITS <br />POLICY NUMBER <br />LTR(MM/DD/YYYY)(MM/DD/YYYY) <br />INSRWVD <br />GENERAL LIABILITY <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />COMMERCIAL GENERAL LIABILITY$ <br />PREMISES (Ea occurrence) <br />CLAIMS-MADEOCCURMED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GENERAL AGGREGATE$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ <br />PRO- <br />$ <br />POLICYLOC <br />JECT <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />(Ea accident)$ <br />BODILY INJURY (Per person)$ <br />ANY AUTO <br />ALL OWNEDSCHEDULED <br />BODILY INJURY (Per accident)$ <br />AUTOSAUTOS <br />NON-OWNED <br />PROPERTY DAMAGE <br />$ <br />HIRED AUTOS <br />(Per accident) <br />AUTOS <br />$ <br />UMBRELLA LIAB <br />EACH OCCURRENCE$ <br />OCCUR <br />EXCESS LIAB <br />CLAIMS-MADEAGGREGATE$ <br />$ <br />DEDRETENTION$ <br />WC STATU-OTH- <br />WORKERS COMPENSATION <br />TORY LIMITSER <br />AND EMPLOYERS' LIABILITY <br />Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT$ <br />N / A <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT$ <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE <br />THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORDACORD 25 (2010/05) <br />Marie Groh <br />NONNI-1OP ID: MG <br />03/14/2013 <br />Phone: 916-721-7272 <br />Associations, Incorporated <br />CRI Lic0C88588 <br />6354 Tupelo Drive <br />Citrus Heights, CA 95621 <br />Marie Groh <br />Fax: 916-721-5577 <br />Leading Insurance Group <br />Nonni's Bistro <br />Jon Magusson <br />425 Main Street <br />Pleasanton, CA 94566 <br />1,000,000 <br />AXX <br />02BPS04184507/01/201207/01/2013 <br />300,000 <br />X <br />5,000 <br />Included <br />2,000,000 <br />2,000,000 <br />X <br />Emp Ben.None <br />NONE <br />NONE <br />NONE <br />Restaurant <br />Certificate Holder is listed as Additional Insured/State or Political <br />Subdivision - Permits as respects to the liability coverage for the Outdoor <br />Seating. <br />CITYPLE <br />City of Pleasanton <br />P.O. Box 520 <br />200 Old Bernal Avenue <br />Pleasanton, CA 94566