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COI - Del Sol Bakery - Expires 2024-04-135tateFarm CAD 0105 ST -0000 STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS P Box 2915 Bloomington IL 61702-2915 Addl Insured -Section II Only AT2 M- 2 2R lR FREE F 7 CITY OF GILROY000605 3125 RC @FRO ERD 7351 ROSANNA ST GILROY CA 95020-6141 FEB -9 2023 GILROY CffY CLERK'S OFFICE Food Shop Policy RENEWAL DECLARATIONS Policy Number 97-CW-B044-0 Policy Period Effective Date Expiration Date 12 Months APR 13 2023 APR 13 2024 The policy period begins and ends at 12:01 am standard time atthe premises -location. Named Insured BATISTA & CARRAZCO INC DBA DEL SOL BAKERY Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 1,449.00 Discounts Applied: Renewal Year Years in Business Protective Devices Sprinkler Claim Record Prepared JAN 30 2023 CMP-4000 003658 294 Al N Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 1 of 7 c In c .. , n5 11 71111 In117771,-1 RENEWAL DECLARATIONS (CONTINUED) Food Shop Policy for CITY OF GILROY Policy Number 97-CW-B044-0 SECTION I - PROPERTY SCHEDULE Location Number Location of Described Premises Limit of Insurance* Coverage A - Buildings Limit of insurance* Coverage B - Business Personal Property Seasonal Increase - Business Personal Property 001 7901 WESTWOOD DR STE K GILROY CA 95020-4745 No Coverage $ 176,900 25% * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. ,SECTION I -INFLATION COVERAGE INDEXfES) Coy A - Inflation Coverage Index: N/A Coy B - Consumer Price Index: 298.0 SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared JAN 30 2023 0 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 003658 Continued on Next Page Page 2 of 7 state Farm ®® 0205•ST -0000 RENEWAL DECLARATIONS (CONTINUED) Food Shop Policy for CITY OF GILROY Policy Number 97-CW-B044-0 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Food Contamination Additional Advertising Expenses $3,000 Per Occurrence $10,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Prepared JAN 30 2023 CMP-4000 003659 294 N U Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 3 of 7 RENEWAL DECLARATIONS (CONTINUED) Food Shop Policy for CITY OF GILROY Policy Number 97-CW-B044-0 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $10,000 Spoilage (applies only to those premises provided Coverage B - Business Personal Property) Expediting Expenses $1,000 On Premises $15,000 Off Premises $5,000 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 SECTION I - EXTENSIONS OF C VERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. LIMIT OF COVERAGE INSURANCE Dependent Property - Loss Of Income $5,000 Employee Dishonesty $10,000 Prepared JAN 30 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 003659 Continued on Next Page Page 4 of 7 State farm ®Y® cor 1.1 ti U, th 0 RENEWAL DECLARATIONS (CONTINUED) Food Shop Policy for CITY OF GILROY Policy Number 97-CW-B044-0 Utility Interruption - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4101 Businessowners Coverage Form FE-6999.3 *Terrorism Insurance Coy Notice CMP-4697 Food Contamination CMP-4705.2 Loss of Income & Extra Expense CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4471 Spoilage Coverage CMP-4698 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income Prepared JAN 30 2023 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 003660 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Food Shop Policy for CITY OF GILROY Policy Number 97-CW-B044-0 CMP-4703.1 Utility Interruption Loss Incm CMP-4857 Actual Cash Value Contents CMP-4795.1 Addl Insd Designated Premises CMP-4260.1 Amendatory Endorsement -CA CMP-4788.1 Addl Insd Mgrs Lessor of Prem CMP-4261 Amendatory Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. rn.4,0142. CM4 Secretary President IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: State Farm® Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM (1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927-HELP (4357) or visit www.insurance.ca.aov/01-cons era Prepared JAN 30 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 003660 Continued on Next Page Page 6 of 7 StateFarm ®'O co lb RENEWAL DECLARATIONS (CONTINUED) Food Shop Policy for CITY OF GILROY Policy Number 97-CW-B044-0 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared JAN 30 2023 CMP-4000 003661 294 N ® Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 5tateFarm ®® STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS) PFogigBoX ni9 i5 BIL 61702-2915 Named Insured M-02-280E-FBFF F Z 0505-ST--0000 BATISTA & CARRAZCO INC DBA DEL SOL BAKERY ATTACHING INLAND MARINE Policy Number 97-CW-B044-0 Policy Period Effective Date Expiration Date 12 Months APR 13 2023 APR 13 2024 The policy period begins and ends at 12:01 am standard time atthe premises location. Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared JAN 30 2023 FD-6007 003662 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-688 0.2 05-31 2011 1o113232c1 -LAW-rIu44-u ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop $ 25,000 $ 500 Included Loss of Income and Extra Expense $ 25,000 Included Prepared JAN 30 2023 FD-6007 003662 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY ® Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530 686 0.2 05 31 2011 Io113233c1