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DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1:01603135 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 Kbdrvfmjof!Tbwjebo NAME: FAX PHONE Tbw.Mvy!Jotvsbodf!Tfswjdft999.839.69:2-!Y.811:5:.531.3267 (A/C, No): (A/C, No, Ext): E-MAIL 8866!Dfoufs!Bwf/kbdljfAtbwmvy/dpn ADDRESS: Tvjuf!2211 INSURER(S) AFFORDING COVERAGENAIC # Ivoujohupo!CfbdiDB:3758Dsvn!'!Gpstufs!Tqfdjbmuz!Jotvsbodf!Dp55631 INSURER A : INSURED Usbwfmfst!Dbtvbmuz!Jotvsbodf!Dpnqboz!pg!Bnfsjdb2:157 INSURER B : Usjnby!Tztufnt-!MMDHsfbu!Bnfsjdbo!F'T!Jotvsbodf!Dpnqboz48643 INSURER C : 676!Fyqmpsfs!Tu/Usbwfmfst!Qspqfsuz!Dbtvbmuz!Dpnqboz!pg!Bnfsjdb36785 INSURER D : BDF!Bnfsjdbo!Jotvsbodf!Dpnqboz33778 INSURER E : CsfbDB:3932Hfnjoj!Jotvsbodf!Dpnqboz21944 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 EACH OCCURRENCE$2-111-111 7 DAMAGE TO RENTED CLAIMS-MADEOCCUR$ 211-111 7 PREMISES (Ea occurrence) MED EXP (Any one person)$6-111 BZZHMP.21425613012031351301203136 PERSONAL & ADV INJURY$2-111-111 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ 3-111-111 PRO- POLICYLOCPRODUCTS - COMP/OP AGG$3-111-111 7 JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ 2-111-111 (Ea accident) BODILY INJURY (Per person)$ ANY AUTO 7 ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ CZZCB:M15362713012031351301203136 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Per accident) AUTOS $ UMBRELLA LIAB EACH OCCURRENCE$6-111-111 7 OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ DZZYTF:51:55.12130120313513012031366-111-111 7 $ DEDRETENTION $ PEROTH- WORKERS COMPENSATION 7 STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ 2-111-111 N / A OFFICER/MEMBER EXCLUDED? EZZVC9Y26:16313012031351301203136 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$2-111-111 If yes, describe under E.L. DISEASE - POLICY LIMIT$2-111-111 DESCRIPTION OF OPERATIONS below FDzcfs!MjbcjmjuzE13246:4113012031351301203136Mjnju;!%2-111-111!0!%2-111-111 GUfdiopmphz!Qspgfttjpobm!MjbcjmjuzWOQM12624:13012031351301203136Mjnju;!%2-111-111!0!4-111-111 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SF;!Bmm!Pqfsbujpot Uif!Djuz!pg!Tboub!Bob-!jut!pggjdfst-!pggjdjbmt-!fnqmpzfft-!boe!wpmvouffst!bsf!jodmvefe!bt!beejujpobm!jotvsfet!po!uif!DHM!qpmjdz!xjui!sftqfdu!up!mjbcjmjuz!bsjtjoh!pvu!pg!xpsl!ps pqfsbujpot!qfsgpsnfe!cz!ps!po!cfibmg!pg!uif!Dpousbdups!jodmvejoh!nbufsjbmt-!qbsut-!ps!frvjqnfou!gvsojtife!jo!dpoofdujpo!xjui!tvdi!xpsl!ps!pqfsbujpot/!Hfofsbm!Mjbcjmjuz dpwfsbhf!jt!dpotjefsfe!qsjnbsz!boe!opo.dpousjcvupsz/ CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Djuz!pg!Tboub!Bob 31!Djwjd!Dfoufs!Qmb{b AUTHORIZED REPRESENTATIVE Tboub!BobDB:3812.5169 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD CzDzouijbNpsbbu2;14qn-Pdu41-3135