CERTIFICATE OF INSURANCE (079)
THIS CERTIFICATE IS ISSIID~~~A~~!Ri~~~~M~I!N ~~~A~D~~~~I~ RIGHTS UPON THE CERTIFICATE HOLDER
THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW,
THE VEGHTE AGENCY
COMPANIES AFFORDING COVERAGES
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COMPANY A
LETTER
COMPAN Y B
LETTER
COMPANY C
LETTER
COMPANY 0
LETTER
COMPANY E
LETTER
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NAME AND ADORESS OF INSURED
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This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time, Notwithstanding any requirement, term or con-
dition 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 to
all the terms, exclusions and conditions of such policies.
COMPANY
LETTER
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AGGREGAT
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
GENERAL LIABILITY
COMPREHENSIVE FORM-
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BODILY INJURY
PREMISES-OPERATIONS
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETED
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BROAD FORM PROPERTY
DAMAGE
INDEPENDENT CONTRACTORS
.RECEIVE
PROPERTY DAMAGE
COMPREHENSIVE FORM
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PERSONAL INJURY
,
MAR '1 1986
8001 L Y INJURY AND
PROPERTY DAMAGE
COMBINED
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PERSONAL INJURY
BODILY INJURY
lEACH PERSON)
BODILY INJURY
lEACH OCCURRENCE)
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OWNED
HIRED
PROPERTY DAMAGE
,
NON.QWNEO
BOD) L Y INJURY AND
PROPERTY DAMAGE
COMBINED
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EXCESS LIABILITY
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UMBRELLA FORM
OTHER THAN UMBRELLA
FORM
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BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
WORKER'S COMPENSATION
and
EMPl.OYER'S LIABILITY
OTHER
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ESCFlIPTION OF OPERATIONS/LOCATIONS/VEHICLES
Cancellation: Should. any of the above descr~b,~,d policies b~ cancelled before the expiration da~e. thereof, the issuin.g com-
pany will endeavor to mail . '.- days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER
DATE ISSUED,
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I:ITY OF Ct..EARWAT!~I~
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