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<br />Ejhjubmmz!tjhofe! <br />DATE (MM/DD/YYYY) <br />Bohjf! <br />CERTIFICATE OF LIABILITY INSURANCE <br />cz!Bohjf!1802203133 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />Bdfwfep! <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />Bdfwf <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />Ebuf;! <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />3133/18/36! <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 />ep <br />2:;3:;41!.18(11( <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />CONTACT <br />PRODUCER <br />Lfssz!!!Xblfmz <br />NAME: <br />Cboojtufs!'!Bttpdjbuft!Jotvsbodf!Bhfodz <br />FAX <br />PHONE <br />)825*!647.7197)825*!647.5165 <br />(A/C, No): <br />(A/C, No, Ext): <br />DB!Mjdfotf!$17:2182 <br />E-MAIL <br />416!28ui!Tusffu <br />lfsszAcbj.jot/dpn <br />ADDRESS: <br />Ivoujohupo!Cfbdi!DB!:3759.531: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />Dpoujofoubm!Dbtvbmuz!Dpnqboz31554 <br />INSURER A : <br />):5:*!4::.:161 <br />INSURED <br />Obujpoxjef!Nvuvbm!Jotvsbodf!Dp34898 <br />INSURER B : <br />Upxotfoe!Qvcmjd!Bggbjst-!Jod/ <br />Pbl!Sjwfs!Jotvsobdf!Dpnqboz45741 <br />INSURER C : <br />2512!Epwf!Tusffu-!Tvjuf!441 <br />Cfb{mfz!Jotvsbodf!Dpnqboz48651 <br />INSURER D : <br />INSURER E : <br />Ofxqpsu!Cfbdi!DB!:3771 <br />INSURER F : <br />Dfsu!JE!22:64 <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDLSUBR <br />POLICY EFFPOLICY EXP <br />INSR <br />TYPE OF INSURANCELIMITS <br />POLICY NUMBER <br />LTR(MM/DD/YYYY)(MM/DD/YYYY) <br />INSDWVD <br />COMMERCIAL GENERAL LIABILITY <br />BY!!!2-111-111 <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />Y <br />CLAIMS-MADEOCCUR$ <br />Z C!718568466819042031331904203134!!!!!411-111 <br />PREMISES (Ea occurrence) <br />MED EXP (Any one person)$ <br />!!!!!!21-111 <br />PERSONAL & ADV INJURY$ <br />!!!2-111-111 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />!!!3-111-111 <br />PRO- <br />Y <br />POLICYLOCPRODUCTS - COMP/OP AGG$ <br />!!!3-111-111 <br />JECT <br />$ <br />OTHER: <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY$ <br />!!!2-111-111 <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person)$ <br />CYZ BDQ!415986386816012031331601203134 <br />OWNEDSCHEDULED <br />BODILY INJURY (Per accident)$ <br />AUTOS ONLYAUTOS <br />NON-OWNED <br />HIREDPROPERTY DAMAGE <br />$ <br />(Per accident) <br />AUTOS ONLYAUTOS ONLY <br />$ <br />UMBRELLA LIAB <br />BYY C!718568467119042031331904203134 <br />EACH OCCURRENCE$ <br />!!!6-111-111 <br />OCCUR <br />EXCESS LIAB <br />CLAIMS-MADEAGGREGATE$ <br />!!!6-111-111 <br />$ <br />Y!!!!21-111 <br />DEDRETENTION$ <br />PEROTH- <br />WORKERS COMPENSATION <br />Y <br />STATUTEER <br />DZ UPXD43822518012031331801203134 <br />AND EMPLOYERS' LIABILITY <br />Y / N <br />ANYP ROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT$ <br />!!!2-111-111 <br />N / A <br />OFFICER/MEMBER EXCLUDED? <br />!!!2-111-111 <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE$ <br />If yes, describe under <br />!!!2-111-111 <br />E.L. DISEASE - POLICY LIMIT$ <br />DESCRIPTION OF OPERATIONS below <br />EQspgfttjpobm!Mjbcjmjuz X412EG32121219042031321904203133 Mjnju!)fbdi <br />$ <br />!!!3-111-111 <br />dmbjn*; <br />jodm!Qfstpobm0Bew!jokvsz Sfufoujpo;!%6-111 Mjnju!)bhhsfhbuf*; <br />$!!!5-111-111 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Djuz!pg!Tboub!Bob-!jut!pggjdfst-!bhfout-!fnqmpzfft-!boe!wpmvouffst!bsf!obnfe!bt!beejujpobm!jotvsfet <br />xjui!sftqfdut!hfofsbm!boe!bvup!mjbcjmjuz!qpmjdz!mjnjut/!Qsjnbsz!boe!opo.dpousjcvupsz!xpsejoh <br />bqqmjft!xjui!sftqfdut!hfofsbm!boe!bvup!mjbcjmjuz!qpmjdz!mjnjut/!Xbjwfs!pg!tvcsphbujpo!bqqmjft!xjui <br />sftqfdut!xpslfs(t!dpnqfotbujpo!qpmjdz!mjnjut/!41.ebz!opujdf!pg!dbodfmmbujpo!gps!voefsxsjujoh <br />sfbtpot!boe!21.ebz!opujdf!pg!dbodfmmbujpo!gps!opo.qbznfou!pg!qsfnjvn!xjmm!cf!tfou!jo!uif!fwfou!pg <br />dpnqboz!fmfdujpo/ <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Djuz!pg!Tboub!Bob <br />Sjtl!Nbobhfnfou!Ejwjtjpo <br />AUTHORIZED REPRESENTATIVE <br />31!Djwjd!Dfoufs!Qmb{b- <br />5ui!Gmpps <br />Tboub!Bob!DB!:3812 <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD <br />Qbhf!2!pg!2 <br /> <br />