CERTIFICATE OF INSURANCE (117)
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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 ALTER THE COVER-
AGE AFFORDED BY THE POLICIES BELOW.
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COMPANIES AFFORDING COVERAGE
COMPANY A
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COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
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THIS IS TO CERTIFY THAT 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
n-RESP'ECT'TcTWRICH'TFfIS CERTIFICATE'MAY- BE ISSUED CJROIIrAY'PERTAIN; 1 HE INStJRANCE. AF FORDEO-BV-TH E-POUett::s DE'SCRIBED'
HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES.
TYPE OF INSURANCE
POLICY NUMBER
POLICY EF"FfCTIVE POLICY EXPIRATION
DATE iMMiOD,/YYl DATE t.MMiOO/YYJ
LIABILITY LIMITS IN THOUSANDS
EA H
OCCURRENCE
AGGREGATE
GENERAL LIABiliTY
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~/(,;'-:-l !'i:~ BODILY
INJUHY
COMPREHENSIVE FORM
PREMISES/OPERA TIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM.PROPERTY DAMAGE
PERSONAL INJURY
PROPE R rY
OAMACiE
81 & PO
COMBINED
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PERSONAL INJURY
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ALL OWNED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BOUI L Y
INJURY
IPER
PERSONI
BDDIL Y
I~JURY
:PE R
Acel DE NTi
AUTOMOBilE LIABILITY
ANY AUTO
PHOPEnTY
DAMAGE
GARAGE LIABI L1TY
BI & PU
CDMBINED
BI & PD
COMBINED
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
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IDISEASE.POLlCY L1MITI
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!DISEASE-EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
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