TUSCANY ESPRESSO AND COFFEE LLC.

Home Browse Search

ACOR13 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD1YYYY) illk� 1 11/17/2025 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 NAME: AUTOMATIC DATA PROCESSING INSURANCE AGCY INC PHONE FAX AIC, (No,Exk: 877 677-0428 A1C,No): 877.677-0430 1 ADP BLVD MS 325 E-MAIL ROSELAND, NJ 07068 ADDRESS:s cbicad travelers.cam (877)677-0428 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED INSURER B: TUSCANY ESPRESSO AND COFFEE LLC 1102 FRENCH ST INSURERC: STE 1 INSURER D: SANTA ANA, CA 92701 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 234545605261713 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 VVITH 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVO POLICY NUMBER MMlDDIYYYY (MMIGOfYYYYI LIMITS COMMERCIAL GENERAL LIABILITY -DAMAGE EACH OCCURRENCE $ D A E TO RENTED CLAIMS-MADE OCCUR PREMISES Ea accunence $ MED EXP(Any one per $ PERSONAL&ACV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ POLICY PRO ❑LOC OTHER; JECT PRODUCTS-COMPIOPAGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHFDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE DE❑ RETENTION$ AGGREGATE A WORKERS COMPENSATION NIA X UB-00850202-25 10/21/2025 10/21/2026 X STATUTE IERH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORlPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICEMM€MBE=R EXCLUDED? u (Mandatory in NHI E.L.DISEASE-EA EMPLOYEE $1,000.000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) AS RESPECTS TO WORKERS COMPENSATION COVERAGE,WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA,VVC 04 03 06(01),HAS BEEN ATTACHED TO THE POLICY IN REGARD TO CITY OF SANTA ANA TO READ AS CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICERS,OFFICIALS,EMPLOYEES,AGENTS AND VOLUNTEERS. APPROVED Sy Tu Tran Nguyen at 11:13 am,Nov 18,2025 CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 CIVIC CENTER PLAZA(M-30) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1988 ACCORDANCE WITH THE POLICY PROVISIONS. SANTA ANA, CA 92702-1988 AUTHORIZED REPRESENTATIVE Re. M. �eifrc�-w d 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD