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® DATE(MM/DD/YYYY)
<br /> ACC OR"
<br /> � CERTIFICATE OF LIABILITY INSURANCE 1/7/2026
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: FirstMark Insurance Group,Inc.
<br /> FirstMark Insurance Group,Inc. PHONE 425 582-9037 ) (425)-608-9187
<br /> p A/C,No,Ext: ( ) (A/C,No
<br /> Agent:Dan Fortune ADDRESS: commercial@firstmarkinsurance.com
<br /> 12918 Mukilteo Speedway Suite C23,PMB 603 INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Lynnwood, WA 98087 INSURER A: Hartford Underwriters Insurance Company 30104
<br /> INSURED INSURER B: THE HARTFORD 00914
<br /> Bay Sprouts LLC;Bean Sprouts Los Angeles;Bean Sprouts Santa Ana INSURER C:
<br /> dba:Bean Sprouts Cafe and Cooking School INSURER D:
<br /> 3902 Milwaukee Street,Unit#14725 INSURER E:
<br /> Madison, WI 53708 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> A Y Y 59 SBA BF8N53 11/13/2025 11/13/2026 PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY ❑ECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> A OWNED SCHEDULED Y Y 59 SBA BF8N53 11/13/2025 11/13/2026 BODILY INJURY(Per accident) $
<br /> AUTOS ONLYN
<br /> AUTOS
<br /> HIRED NON-OWNED $
<br /> X AUTOS ONLY AUTOS ONLY (Per accident)
<br /> X UMBRELLA LAB MCLAIMS-MADE
<br /> OCCUR EACH OCCURRENCE $ 6,000,000
<br /> A EXCESS LAB Y Y 59 SBA BF8N53 11/13/2025 11/13/2026 AGGREGATE $ 6,000,000
<br /> DED I X I RETENTION$ 10,000 $
<br /> ORKERS COMPENSATION X STATUTE ER
<br /> ND EMPLOYERS'LIABILITY
<br /> NY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br /> N E.L.EACH ACCIDENT $ 1,000,000
<br /> B FFICER/MEMBER EXCLUDED? N/A Y 59 WEC AC9055 07/03/2025 07/03/2026
<br /> Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> Limit: 50,000
<br /> A DATA BREACH-DEFENSE AND LIABILITY-(CLAIMS MADE) 59 SBA BF8N53 11/13/2025 11/13/2026 Deductible: 1,000
<br /> Retro Date:11/13/2018
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Re:Agreement:A-2024-026.Cafe Services at Zoo 1801 E Chestnut Ave,Santa Ana,CA 92701
<br /> City of Santa Ana,Santa Ana Zoo,its City Council,its officers,officials,employees,agents,or volunteers are included as an Additional Insured with respect to General
<br /> Liability,Auto Liability,and Umbrella Liability where required by written contract.Waiver of Subrogation applies in favor of the Additional Insureds where required by
<br /> written contract.Coverage is Primary and Non-Contributory.30-day written notice of cancellation applies;10-days in the event of non-payment of premium.
<br /> APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION BY Tu Tran Nguyen at 12:13 pm 15,Jan 07,202
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Santa Ana Zoo AUTHORIZED REPRESENTATIVE
<br /> 1801 E Chestnut Ave. Mw i.e Lo-ra—
<br /> Santa Ana,CA 92701
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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