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CERTIFICATE OF INSURANCE
GATE (MM/DD/YY)
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PRODUCER
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INSURED
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
L ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE I
COMPANY
A
.COMPANY
B
I COMPANY
C
COMPANY
D
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THIS IS TO CERTIFY THAT 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
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TlD-ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION; LIMITS
DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
j CLAIMS MADE 1 OCCUR
OWNER'S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
•
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
: NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION AND
EMPLOYERS' LIABILITY
•
; GENERAL AGGREGATE j $ I L •
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THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: y EXCL
OTHER
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PRODUCTS-COMP/OP AGG . $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) : $
MED EXP (Any one person) $
COMBINED SINGLE LIMIT : $
BODILY INJURY
(Per person)
BODILY INJURY
: (Per accident)
$
'$
PROPERTY DAMAGE $
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
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EACH OCCURRENCE $ l .il .
4 1 / ' :- j AGGREGATE $ . .•. I
I ' STATUTORY LIMITS
/ `' . : EACH ACCIDENT $ 4 '1
DISEASE - POLICY LIMIT $ J . J: F:;
DISEASE - EACH EMPLOYEE $
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
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CERTIFICATE HOLDER
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ACORD 2 -S (3/93)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
DAY•'. WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMP 0;4! AGENTS OR_
P9REPRESENTATIVES.
AUTHORIZEDREESENTATIVE
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