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DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2104203136 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 have ADDITIONAL INSURED provisions or 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 Bnz!!!Xfnqmf NAME: Wbo!Cfvsefo!Jot/!Tfsw-!Jod/!.!Ljohtcvsh FAX PHONE )66:*!9:8.3:86)66:*!9:8.5181 (A/C, No): (A/C, No, Ext): QP!Cpy!78 E-MAIL bxfnqmfAwbocfvsefo/dpn ADDRESS: Ljohtcvsh!DB!:4742 INSURER(S) AFFORDING COVERAGENAIC # OZ!Nbsjof!'!Hfofsbm!Jot!Dp27719 INSURER A : INSURED Tubstupof!Obujpobm!Jotvsbodf!D365:7 INSURER B : SQX!Tfswjdft-!Jod/ Dbqjupm!Tqfdjbmuz!Jot!Hspvq21439 INSURER C : QP!Cpy!6328 INSURER D : INSURER E : Psbohf!!DB!:3974! )825*!981.7463 INSURER F : KLDfsu!JE!68622)49:* 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 BY!!!2-111-111 EACH OCCURRENCE$ DAMAGE TO RENTED Y CLAIMS-MADEOCCUR$ ZZ QL31361111973921019031362101903137!!!!!211-111 PREMISES (Ea occurrence) MED EXP (Any one person)$ !!!!!!!6-111 PERSONAL & ADV INJURY$ !!!2-111-111 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ !!!3-111-111 PRO- Y POLICYLOCPRODUCTS - COMP/OP AGG$ !!!3-111-111 JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY$ (Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS NON-OWNED HIREDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB CY 98611W36:BMJ21019031362101903137 EACH OCCURRENCE$ !!!3-111-111 OCCUR EXCESS LIAB Y CLAIMS-MADEAGGREGATE$ !!!3-111-111 $ Qspe0Dpnq!pq!Bh!!!3-111-111 DEDRETENTION$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANYP ROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below BQpmmvujpo QL31361111973921019031362101903137%2-111!Efevdujcmf $ !!!2-111-111 DQspgfttjpobm!Mjbcjmjuz THD111442:.2423018031352301803136 Fbdi!Fsspofpvt!Bdu $!!!2-111-111 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Djuz!pg!Tboub!Bob-!jut!Djuz!Dpvodjm-!pggjdfst-!pggjdjbmt-!fnqmpzfft-!bhfout-!boe!wpmvouffst!bsf obnfe!beejujpobm!jotvsfe!qfs!buubdife!foepstfnfou/!Xbjwfs!bqqmjft!up!Hfofsbm!Mjbcjmjuz/ CzUvUsboOhvzfobu3;56qn-Opw14-3136 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 AUTHORIZED REPRESENTATIVE 31!Djwjd!Dfoufs!Qmb{b Tboub!Bob!DB!:3812 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD Qbhf!2!pg!3