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Aco "' CERTIFICATE OF LIABILITY INSURANCE 1 DAT2/4/2D/YYYY)
<br />2/a/2o1z
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />2?LO'1V. TH13 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />VP_?RTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />:'a tens and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />:eri`_ate holder in lieu of such endorsement(s).
<br />e _` 're Americas
<br />c %Y 1-C36
<br />I%SURED
<br />Sirrp, exGrinnell LP
<br />12728 Shoemaker Avenue
<br />Santa Fe Springs, CA 90670
<br />United States
<br />NAME?v Shavna Chauhan
<br />PHONE (AIC_No Extl• (212) 345-8735 (AIQ Not:
<br />- (212) 948-8852
<br />E-MAIL
<br />ADDRESS:-..-Please see bottom of 2nd page
<br /> INSURER(S) AFFORDING COVERAGE NAIC A
<br />INSURER A: AGCS Marine Insurance Company (Allianz) 22837
<br />INSURER B: Commerce & Industry Ins Co. 19410
<br />INSURER C: Illinois National Insurance Co. 23817
<br />INSURER D: Nat'l Union Fire Ins Co. of Pittsburgh, PA 119445
<br />INSURER E: New Hampshire Ins. Co. {23841
<br />CAVFRA(AFS. rtCDTICIPATC NIITRAMCO.11n7n7eo A
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
<br />
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. ,
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADDL
<br />LTR TYPE OF INSURANCE SUBR
<br />POLICY NUMBER POLICY EFF^ POLICY EXP
<br />MM/DDIYYYY I IMMIDONYYY1 LIMITS
<br />E GENERAL LIABILITY X
<br />, X GL 7146417 (Primary GL) 9/28/2012 10/1/2013 EACH OCCURRENCE $ $1,000,000.00
<br /> X
<br />_COMMERCIAL GENERAL LIABILITY
<br />DAMAGE T PREMISES (Ea occurrence) S $1,000000.00
<br /> CLAIMS-MADE OCCUR; $10,000.00
<br />MED EXo (Any one person) S
<br /> OWNER'S & CONTRACTOR'S PROT
<br />- _ _
<br />r
<br />PERSONAL & ADV INJURY $ $1,000,000.00
<br /> I
<br /> EN
<br />RAL AGGREGATE $ _ $2,000,000.00
<br /> GENT AGGREGATE LIMIT APPLIES PER: ?G
<br />E
<br />OUCTS-COMP/OP AGGS $2,000,000.00
<br />--- -
<br /> X '' POLICY I PRO- LOC , S
<br />D I AUTOMOBILE LIABILITY
<br />X
<br />X
<br />CA 3447245 (All Other States) i 9/2 812 01 2 j 10/1/2013 COMBINED SINGLE LIMIT
<br />5 $1,000,000.00
<br />Ea accident)
<br />D X ANY AUTO CA 3447251 (MA) 9/28/2012 10/1/2013 -
<br />BOp JURY (Per person) S
<br />D
<br />E I ALL OWNED SCHEDULED
<br />J AUTOS
<br />AUTOS i CA 3447254 (VA) 9/28/2012 10/1/2013
<br />9/2 -
<br />BODILY INJURY (Per accident) S
<br /> _
<br />I__ 8/2012 10/1/2013
<br />CA 3447252 (NH) (Primary AL)
<br /> 'X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE -T
<br /> AUIOS (Peraccident)
<br /> NEW HAMPSHIRE CSL S $250,000.00
<br /> UMBRELLA LAB OCCUR EACH OCCURRENCE $
<br />
<br />EXCESS LAB CLAIMS-MADE _
<br />. AGGREGATE PRODUCTS- S
<br />
<br /> DED RETENTIONS : NEW HAMPSHIRE (CSL) S
<br />
<br />B WORKERS COMPENSATION
<br />I.
<br />AND EMP
<br />Y
<br />' WC 043464663
<br />(FL) 9/28!2012
<br />10/1/2013
<br />X '/`? STATU- .0TH-
<br /> LO
<br />ERS
<br />LIABILITY
<br />YI
<br />N WC 043464672 (MI)
<br />
<br />D ?
<br />,
<br />ANY PROPRIETOR!PARTNERlEXECUTIVE
<br />NIA.
<br />OFFICER,MEMBER ExCLUDED1 9128/2012
<br />
<br />WC 043464662 (GA)
<br />1 9/28!201
<br />2 10/1/2013
<br />
<br />
<br />1D/1/2013
<br />
<br />_L. EACH ACCIDENT S $2,000,000.00
<br />: EN
<br />(Mandato In NH
<br />cr WC 043464661 (All Other States
<br />) 9/28/2012 1011/2013 000
<br />000.00
<br />E L. DISEASE - EA EMPLOYEE S $2
<br />E f gs des
<br />be under
<br />D SCR 'F-,ON CF OPERATIONS below WC 043464673 (MN)
<br />9/28/2012 10/1/2013 ,
<br />,
<br />E.L. DISEASE -POLICY LIMIT I S $2,000,000.00
<br />A Eu leer's Rlsk nstaJa:ion;Conrrac: 1','orks OC & 00',! 9'128600 9;28/2012 1011/2013 USD $1.000,C00.00 per jobsite
<br />A Renal EQ:?pmer.Ce-:ractc-s Ec_ :r-en: OC IS 0Z'-J 9'1286CO 928 2012 10,%112013 USD 51,000,0OO.OD per jobsite
<br />A a?<e -rF, _ . 28^=. 9 282.12 1C'1 2013 USD S1,000,COO.00 per conveyance
<br />CESCRIPTIO'. OF CPER-_:1.S '_...... C•.S '.'E? :_ES ,-ac? 4:CRC 'C• A.,_ .,c-.?' Reau-a Schell We. A more space is required)
<br /> __. __de9 as addit_cnal
<br /> '- - _n::-- _-=- -=retract, per the
<br />
<br />-- _?' -E x_: .E :ES:R:BE: DO:ZIES BE CANCELLED BEFORE
<br />_= cs?=j'C? a- =EREG= %:7-E WILL BE DELIVERED IN
<br />ACORD 25 (2010105)
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<br />R fop r-0 ?Jj 015 av 4
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