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AC'COR0 CERTIFICATE OF LIABILITY INSURANCE DArE(MMIDDIYYYY) <br />11/10/2017 <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 />{MPC7RTANT: If tl�e Gt:rtificatta Folder is an ADbITIONA-L INSURED), tho policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the {policy, certain policies may require an endorsement. A Statement on this certificate does not confer rights to the <br />certificate holder in lion of such endorsement{5}, _ <br />�.� �..__ w ..__.-.... <br />PRODUCER <br />CONTACT <br />NAME: <br />HISCOX Inc, d/b/a/ HiSCOX Insurance; Agency in CA <br />520 Madison Avenue <br />I rpt 1. c,.,1. (888) 202•-3007 FVC Not <br />ADDRESS: Contact@hiscox.corn <br />INSURERS AFFORDING COVERAGE NAIC IF <br />32nd Floor <br />INSURER A ; Hiscox Insurance Company Inc, 102.00 <br />New Yoric, NY 10022 _ _ <br />INSURER B <br />INSURED <br />7 r/ r/QO <br />1\ <br />N-2017-078-01 <br />Luis Martinez —2O 1 / —O / —O 1 <br />INSURER C: <br />INSURER 11: <br />62 Civic Center Plaza <br />PO Box 1061 <br />INSURER E: <br />_ <br />INSURER F: <br />Santa Ana GA 92703 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE: POLICIES CF INSURANCE LISTED BELOW HAVE BEEN ISSUED 1-0 THE INSURED NAMED AEIOVE FOR THE. POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI -+S <br />CERTIFICATE= MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TI -1%_ 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 />ILTR <br />TYPE OF INSURANCE <br />I UL <br />SU <br />POLICY NUMBER <br />POLICY CFF <br />POLICY EXP <br />MMIDD/YYYY <br />LR�ITS <br />X COMMERCIAL. GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />_ _______ <br />EAChIOCCURRENCE $ 1,000,000 <br />DAMAGE S O RENTED <br />PREMISE. Fa occurrence $ 100,000 <br />M 17 EXP (Any one person) $ 5,000 <br />�' <br />PERSONAL &ADV INJURY S 1,000,000 <br />A <br />ULC -.1654609 -COL -17 <br />11/04/2017 <br />1'1/04/2018 <br />GENE:RALAGGREGATI S 2,000,000 <br />\GE=N'L AGGREGATE LIMIT APPLIES PER: <br />/� POLICY I PRO- LOC <br />�1 JECT <br />PRODUCTS • COMP/OP AGG S 5/ T Gen. A . <br />$ <br />OTHER, <br />AUTOMOBILELIABILITY <br />COMBINED SINGLE LIMIT � <br />Ee accident <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />�. <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Por accident) $ <br />NON -OWNED <br />HIREDAEITOS AUTOS <br />PROPE:R`rY DAMAGE <br />(Per accidenth <br />$ <br />MACH OCCURRENCE <br />UMBRELLA LIAR OCCUR <br />_ <br />AGGREGATE $ <br />_ <br />EXCESS LIAR CLAIMS -MADE <br />DED I fdE'1'EN'f10N$ <br />WORKERS COMPENSATION <br />_ <br />PER UTH- <br />AND EMPLOYERS' LIABILITY Y / N <br />ANYPROPRIE'rOR/PAR'rNER/EXECU'FIVE <br />OFFICERlMEMI3ERLXCLLIDL"D7 LJ <br />N I A <br />S;iA'rUTF I ER <br />FA.. EAGFi ACCIDENT' u <br />L. UISF.'ASF. - EA GMIFL.OYEE <br />(Mandatory in NH) <br />If yes, describe under <br />ELL, DISEASE • POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below. <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 141, Additional Rounarks Schedule, may be attached If more space Ja required) <br />1 <br />41, I�C�.� s a r� <br />G�Zo <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCR[BED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name; and logo are registered marks of ACORD <br />