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CERTIFICATE OF LIABILITY INSURANCE (11) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1201703131 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: Cvslf!Jotvsbodf!Tfswjdft!Jod FAX PHONE 838.552.41:5 838.55:.1213 (A/C, No): (A/C, No, Ext): Q!P!Cpy!2245 E-MAIL dpmmffoAcvslfjottfswjdft/dpn Evofejo-!GM!!457:8 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # BMMJBODF!PG!OPOQSPGJUT!GPS!JOTVSBODF!SJTL!SFUFOUJPO 21134 INSURER A : INSURED Obujpobm!Mjbcjmjuz!'!Gjsf!Jotvsbodf!Dp 31163 INSURER B : Es/!Nbsujo!Mvuifs!Ljoh!Ks/!Ofjhicpsippe!Gbnjmz!Dfoufs!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 3131.56:712012031311201203132 Y2-111-111 EACH OCCURRENCE$ BYY DAMAGE TO RENTED )!jodmveft!Jnqspqfs!Tfyvbm! !!!!!611-111 CLAIMS-MADEOCCUR$ 9 PREMISES (Ea occurrence) Dpoevdu* QSPGFTTJPOBM Y!!!!!31-111 MED EXP (Any one person)$ 12012031311201203132 EJSFDUPST!'!PGGJDFST!%2-111-111 3131.56:7 Y2-111-111 PERSONAL & ADV INJURY$ 4-111-111 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- Y4-111-111 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ 12012031311201203132 3131.56:7 2-111-111 BY (Ea accident) BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ Y AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Per accident) AUTOS $ UMBRELLA LIAB 12012031311201203132 3131.56:7 YY6-111-111 EACH OCCURRENCE$ OCCUR EXCESS LIAB B6-111-111 CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION 12018031311201803132 B:XD22357 Y C STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE 611-111 E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH)611-111 E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 611-111 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below BVUP!QIZTJDBM!EBNBHF12012031311201203132%2-111!!DPNQSFIFOTJWF!EFEVDUJCMF 3131.56:7 Y %2-111!!DPMMJTJPO!EFEVDUJCMF B DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Djuz!pg!Dmfbsxbufs!jt!obnfe!bt!beejujpobm!jotvsfe!xjui!sftqfdut!up!Hfofsbm!Mjbcjmjuz!boe!Bvup!Mjbcjmjuz 3128!Difwspmfu!!$2HBXHFGG4I2297418 3128!Difwspmfu!!$2HBXHFGGYI229988: CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Djuz!pg!Dmfbsxbufs! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Q/!P/!Cpy!5859 ACCORDANCE WITH THE POLICY PROVISIONS. Dmfbsxbufsu-!GM!!44867 AUTHORIZED REPRESENTATIVE Colleen B. Burke © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD