RITA'S ITALIAN ICE GAULIN, JOHN D. OUTDOOR DINING PERMIT

A ® ATE IMMIDDmYYI CERTIFICATE OF LIABILITY INSURANCE D05/12/2017 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 endorsement(s). PRODUCER NAME Huber Renee Huber, Agent A : nerve State Farm Insurance PH(A/C nil'925-484-2222 FAX ,No):925-484-1716 312 St Mary Street Ste A dun ESS:[email protected] Pleasanton, CA 94566 INSURER(S)AFFORDING COVERAGE NAICA INSURER A:State Farm General Insurance Company 26161 INSURED GAULIN, JOHN&ARELLANO, GREG INSURER B: DBA RITA'S OF PLEASANTON INSURERC: 320 SAINT MARY ST, PLEASANTON, CA 94566 INSURERO: 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. INSR TYPE OF INSURANCE ADDL SUBR POUCY EFF POLICY EXP LEWIS LTR INSR MD POLICY NUMBER IMWDBWYYY) IMMIDDIYTYYI GENERAL UABIUTY fl Ill EACH OCCURRENCE 5 2,000,000 X COMMERCIAL GENERAL LIABILITY I PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE I Xi OCCUR 97-CU-Y180.7 03/0312017 03(03/2018 MED EXP(Any one parson) $ 5.000 PERSONAL S ACV INJURY 5 2.000,000 • GENERAL AGGREGATE $ 4,000,000 GENE AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2,000,000 POLICY JETT I LOC $ AUTOMOBILE LIABILITY ((A COMBINED SINGLE LIMIT 5 ANY AUTO BODILY INJURY(Per person) S _ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED —PROPERTY E 5 HIRED AUTOS AUTOS (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE 5 EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION 5 $ WORKERS COMPENSATION WC STATU. OTH- AND EMPLOYERS'LIABILITY TORY UNITS ER i ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" E.L.EACH ACCIDENT $ OFFICE/MEMBER EXCLUDED, I N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ II yes,desaibe under E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below u DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remelts Schedule,II more apace Is roquIrodI Indemnification/Insurance.The permittee shall defend,indemnify and hold harmless the city and Its officers and employees from and against all claims,losses. damage,injury and liability for damages arising from the permittee's use of the public right-of-way.The permlttee shall provide to the city In a form and in amounts acceptable to the city attorney,certificates of Insurance evidencing the existence of a general liability policy covering the area subject to the permit. CERTIFICATE HOLDER CANCELLATION CITY OF PLEASANTON,COMMUNITY DEVELOPMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DEPARTMENT PLANNING DIVISION ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 520/200 OLD BERNAL RD AUTHORIZED r{BPR8SENTATIVE PLEASANTON,CA 94566 I � L p(1988- 0 ACOR ORATIb . All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 L--