CERTIFICATE OF INSURANCE (29)
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This certificate is e;"",,uted b Liberty Muulal IllSuraocc GlOup as respects such irnurancc as is afforded b t1Dsc con anics.
Certificate of Insurance
This certificate is issued as a manec of infonnatioa only aa:l confers DO righrs upon you the certificate tDlder This certificate is Il()( an insuraoce policy and does 0)( amem, extend, or alter the coverage
afforded b the lieles listed below.
This is to certify that IName and address of Insured)
BM0068
MALCOLM PIRNlE INC
104 CORPORATEPARKDRlVE
WHITEPLAlNS, NY 10604
~ Liberty,
~ Mutuat~.
13, at the issue date of tlris certificate, inslUed by the Company under tlle poheylies) listed below. TIE llImrance afforded by the listed poIicY(les) 13 subje(~ to all their teons, exelnsions and conditions and
is oot altered bv anv rerntlrellleut, term or COu:.litiOll uf au\! contract or other OOLl.lUletll with resua:t to wlriLiJ this certificale lU3V be issued.
EXIli1'ation TVlle Etl'.lExll, Dote! s) Policy Number(s) Lilnits of Liability
Continuous* 02/0112007 / 02/01/2008 WC7121 092033017 Coverage afforded under WC low of Employers Liability
- the following states:
Extendcd Bodily Injury By Accident
-
X Policy Tcrm All States except Mooopolistic States $1,000,000 Each Accident
Bodily Injury By Disease
$1,000,000 Policy Lilnit
WOl'kel's Compensation Bodily Injury By Disease
$1,000,000 Each Person
General Aggregate-Other than Prod/Completed Operations
Genel'al Liability
Products/Completed Ollel'ations Aggregate
H Claims Made
Occuncnce Bodily Injury and Property Damage Liability Pcr
Occurrence
I Retro Date I Personal and Advertising Injury Per Person /
Orllanization
Other Liability I Othel' Liability
Each Accident - Single Limit. B. I. and P. D. Combined
Automobile Liability
Each Person
- Owned
- Non-Owned Each Accident or Occunence
Hircd
Each Accident or Occurrence
'CANCELLATION CLAUSE DOES NOT APPLY TO NON-PAYMENT OF PREMllJM.
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Notice of cancellation: (n,:>t afl.'lic.~ble t:.nless a nurnbcr of days is entered bcle.w:' BdoN: the stated <'Xpiration date the company will not cancel or reduce the insurance aff Jrded under the above
polici~~ WillI at ]ca~t 30 J<I)':> rv)t;..:e ,::;[ ~llch callcdkl.ioll h,,::; b~ll mctileJ l0
Office: TARRYTOWN, NY -COMM MKTS Phone: 914-332-9770 C~ .-~ '.i n ~)0~~,v,-
I - 0.. .1.. !U-_
Certificate Holder: FAITH KEEGAN
City Clerk Authorized Renresentative
City cf Clearwater
?o. Bo:-: ':i7cJc3
Clearwater, "~ 33758
Date Issued: 0612812007 Prepared By: DG