Nancy Bronstein
DocuSign Envelope ID: F6C77702-6F78-4FFA-B3D8-1CC7A1F39157
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
CANCELLATION
ACORD 28 (2016/03)
© 2003-2015 ACORD CORPORATION. All rights reserved.
NO
YES
NO
YES
If YES, LIMIT:
DED:
Subject to Different Provisions:
Subject to Different Provisions:
NAMED STORM INCL
DED:
If YES, LIMIT:
If YES, LIMIT:
If YES, LIMIT:
If YES, LIMIT:
If YES, LIMIT:
If YES, LIMIT:
If YES, LIMIT:
RENTAL VALUE
N/A
FUNGUS EXCLUSION (If "YES", specify organization's form used)
LIMITED FUNGUS COVERAGE
$
EARTH MOVEMENT (If Applicable)
WIND / HAIL INCL
ORDINANCE OR LAW
EQUIPMENT BREAKDOWN (If Applicable)
COINSURANCE
AGREED VALUE
REPLACEMENT COST
DED:
IS DOMESTIC TERRORISM EXCLUDED?
IS THERE A TERRORISM-SPECIFIC EXCLUSION?
Attach Disclosure Notice / DEC
TERRORISM COVERAGE
BLANKET COVERAGE
YES
NO
COVERAGE INFORMATION
FLOOD (If Applicable)
PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE
HOLDER PRIOR TO LOSS
If YES,
%
DED:
COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE:
DED:
PERILS INSURED
BASIC
BROAD
SPECIAL
- Demolition Costs
- Incr. Cost of Construction
- Coverage for loss to undamaged portion of bldg
DED:
DED:
DED:
DED:
DED:
If YES, indicate value(s) reported on property identified above: $
BUSINESS INCOME
If YES, LIMIT:
Actual Loss Sustained; # of months:
If YES, LIMIT:
AUTHORIZED REPRESENTATIVE
ADDITIONAL INTEREST
NAME AND ADDRESS
LENDER SERVICING AGENT NAME AND ADDRESS
CONTRACT OF SALE
MORTGAGEE
LENDER'S LOSS PAYABLE
LOCATION / DESCRIPTION
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 EVIDENCE OF PROPERTY INSURANCE 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. (ACORD 101 may be attached if more space is required)
BUILDING OR
BUSINESS PERSONAL PROPERTY
THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.
ADDITIONAL NAMED INSURED(S)
NAMED INSURED AND ADDRESS
CODE:
AGENCY
CUSTOMER ID #:
SUB CODE:
E-MAIL
ADDRESS:
(A/C, No, Ext):
PHONE
FAX
(A/C, No):
PRODUCER NAME,
CONTACT PERSON AND ADDRESS
EXPIRATION DATE
EFFECTIVE DATE
THIS REPLACES PRIOR EVIDENCE DATED:
TERMINATED IF CHECKED
CONTINUED UNTIL
IF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACH
COMPANY NAME AND ADDRESS
NAIC NO:
POLICY TYPE
POLICY NUMBER
LOAN NUMBER
EVIDENCE OF COMMERCIAL PROPERTY INSURANCE
DATE (MM/DD/YYYY)
The ACORD name and logo are registered marks of ACORD
PROPERTY INFORMATION
LOSS PAYEE
10/8/2021
408-973-9500
27154
Arthur
J.
Gallagher
&
Co.
Insurance
Brokers
of
CA.
Inc
|
LIC
#0726293
160
West
Santa
Clara
Street
Suite
300
San
Jose,
CA
95113
408-257-2985
Atlantic
Specialty
Insurance
Company
One
Beacon
Lane
Canton,
MA
Amber
Kinetics
Inc
32920
ALVARADO
NILES
RD
STE
250
Union
City,
CA
94587
711-01-68-90-0002
10/04/2021
10/04/2022
X
X
X
1,921,150
$1,000
X
X
$988,103
X
X
X
X
X
$15,000
$1,000
X
X
X
X
X
Included
X
X
X
X
X
X
X
X
City
of
Alameda
C/O
RiverRock
Real
Estate
Group
950
West
Mall
Square
STE
239
Alameda,
CA
94501
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