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<br />Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! <br />Upsj!Qjfstpo <br />Ebuf;!3133/18/2:!22;33;5:!.18(11( <br />DATE (MM/DD/YYYY) <br />CERTIFICATE OF COVERAGE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS NO RIGHTS <br />PRODUCER <br />UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR <br />NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />MEMORANDUM(S) OF COVERAGE BELOW. <br />THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE <br />ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE <br />CERTIFICATE HOLDER. <br />IMPORTANT: IF THE CERTIFICATE HOLDER IS ANADDITIONAL COVERED PARTY, THE <br />MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE <br />DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH <br />ENDORSEMENT(S). <br />NAMED COVERED PARTY <br />IMPORTANT: IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE <br />MEMORANDUM(S) OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON <br />THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH <br />ENDORSEMENT(S). <br />PROGRAM AFFORDING COVERAGE <br />A: <br />B: <br />C: <br />COVERAGES <br />THIS IS TO CERTIFY THAT THE COVERAGE ISAFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE PERIOD SHOWN BELOW, NOT WITHSTANDINGANY <br />REQUIREMENT, TERM ORCONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED ORMAY PERTAIN. THE COVERAGE AFFORDED BY THE PROGRAM <br />DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCHMEMORANDUM(S) OF COVERAGE. THE FOLOWINGCOVERAGE IS IN EFFECT. <br />JPACOVERAGE EFFECTIVECOVERAGE EXPIRATION <br />TYPE OF COVERAGEMEMORANDUM NUMBERLIMITS <br />LTRDATE (MM/DD/YY)DATE (MM/DD/YY) <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />% <br />COMMERCIAL GENERAL LIABILITYFIRE DAMAGE (Any one fire)% <br />CLAIMS MADEOCCURMED EXPENSE (Any one person)% <br />PERSONAL & ADV INJURY% <br />GENERAL AGGREGATE% <br />GEN’L AGGREGATE LIMIT APPLIES PER:PRODUCTS-COMP/OP AGG% <br />MEMOR- <br />PROJECTLOC <br />ANDUM <br />AUTOMOBILE LIABILITY <br />% <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />ANY AUTO% <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON-OWNED AUTOS <br />WC <br />OTHER <br />WORKERS’ COMPENSATION AND <br />STATUTORY <br />EMPLOYERS LIABILITY <br />LIMITS <br />ANY PROPRIETOR/PARTNER/ <br />E.L. EACH ACCIDENT% <br />EXECUTIVE/OFFICER/MEMBER <br />EXCLUDED? <br />E.L. DISEASE –EA EMPLOYEE <br />% <br />IF YES, DESCRIBED UNDER SPECIAL <br />PROVISION BELOW <br />E.L. DISEASE –POLICY LIMIT% <br />OTHER <br />OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE <br />BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE <br />PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br /> <br />