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CERTIFICATE OF LIABILITY INSURANCE (5)
DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 190120312: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER Dpmmffo!C!Cvslf NAME: FAX PHONE Cvslf!Jotvsbodf!Tfswjdft-!Jod 838.552.41:5838.55:.1213 (A/C, No): (A/C, No, Ext): E-MAIL Q/P/!Cpy!2245 dpmcvslfAipunbjm/dpn ADDRESS: Evofejo-!GM!!457:8 INSURER(S) AFFORDING COVERAGENAIC # Vojufe!Tubuft!Mjbcmjuz!Jotvsbodf!Dpnqboz INSURER A : INSURED Opsnboez!Jotvsbodf!Dpnqboz INSURER B : Zpvui!Efwfmpqnfou!Jojujbujwft-!Jod INSURER C : :11!Nbsujo!Mvuifs!Ljoh!Ks!Bwfovf INSURER D : Dmfbsxbufs-!GM!!44866 INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1901203131 OQQ2677:84E190120312: Y2-111-111 EACH OCCURRENCE$ BY DAMAGE TO RENTED 611-111 CLAIMS-MADEOCCUR$ 9 PREMISES (Ea occurrence) 6-111 MED EXP (Any one person)$ 2-111-111 PERSONAL & ADV INJURY$ 3-111-111 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2-111-111 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ OQQ2677:84E190120312:1901203131 2-111-111 BY (Ea accident) BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ YY HIRED AUTOS (Per accident) AUTOS $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION OIGM122743312:140370312:1403703131 Y B STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE 211-111 E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH)211-111 E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 611-111 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below Qspgfttjpobm!MjbcjmjuzOQQ2677:84E190120312:1901203131%2-111-11103-111-111!Pddvsfodf0Bhhsfhbuf Ejsfdupst!'!Pggjdfst!Mjbcjmjuz!x0FQM+%2-111-11103-111-111!Pddvsfodf0Bhhsfhbuf BY Bcvtf!'!Npmftubujpo%2-111-11102-111-111!Pddvsfodf0Bhhsfhbuf DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) M.855OQQ!17021!!Cmbolfu!Beejujpobm!Jotvsfe +!Fnqmpznfou!Qsbdujdft!Mjbcjmjuz!jodmvefe!jo!Ejsfdupst!'!Pggjdfst2-111-111 +!Dzcfs!Mjbcjmjuz!Tvc!Mjnju!%61-111 CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Djuz!pg!Dmfbsxbufs ACCORDANCE WITH THE POLICY PROVISIONS. 211!T/!Nzsumf!Bwfovf Dmfbsxbufs-!GM!!44867 AUTHORIZED REPRESENTATIVE Dpmmffo!C/!Cvslf © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD