CERTIFICATE OF INSURANCE (263)
This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies.BM0068
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend, extend,
or alter the coverage
afforded by the policies listed below.
This is to certify that (Name and address of Insured)
MALCOLM PIRNIE INC
104 CORPORATE PARK DRIVE
WHITE PLAINS, NY 10604
is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms,
exclusions and conditions and
is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued.
Expiration TypeLimits of Liability
Eff./Exp.Date(s)PolicyNumber(s)
Employers Liability
Continuous*
Coverage afforded under WC law of
02/01/2008 /02/01/2009WC7-121-092033-018
the following states:
Bodily Injury By Accident
Extended
XEach Accident
Policy Term$1,000,000
All States Except Monopolistic States
Bodily Injury By Disease
Policy Limit
$1,000,000
Workers CompensationBodily Injury By Disease
Each Person
$1,000,000
General Aggregate-Other than Prod/Completed Operations
General Liability
Products/Completed Operations Aggregate
Claims Made
Bodily Injury and Property Damage LiabilityPer
Occurrence
Occurrence
Retro DatePersonal and Advertising Injury Per Person /
Organization
Other LiabilityOther Liability
Each Accident -Single Limit -B. I. and P. D. Combined
Automobile Liability
Each Person
Owned
Each Accident or Occurrence
Non-Owned
Hired
Each Accident or Occurrence
*CANCELLATION CLAUSE DOES NOT APPLY TO NON-PAYMENT OF PREMIUM.
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C
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M
M
E
N
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Notice of cancellation: (not applicable unless a number of days is entered below) . Before the stated expiration date the company will not cancel or reduce the insurance afforded under
the above
30
policies until at least days noticeof such cancellation has been mailed to:
Office :Phone:
TARRYTOWN, NY-COMM MKTS914-332-9770
Certificate Holder:
FAITH KEEGAN
City Clerk Authorized Representative
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758
:01/29/2008DG
Date IssuedPrepared By: