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TM <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />INSR ADD’L <br />LTR INSRD <br />DATE (MM/DD/YYYY) <br />PRODUCER <br />INSURED <br />POLICY EFFECTIVE POLICY EXPIRATIONPOLICY NUMBER LIMITSDATE (MM/DD/YY) DATE (MM/DD/YY)TYPE OF INSURANCE <br />GENERAL LIABILITY <br />AUTOMOBILE LIABILITY <br />GARAGE LIABILITY <br />EXCESS/UMBRELLA LIABILITY <br />WORKERS COMPENSATION AND <br />EMPLOYERS’ LIABILITY <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />INSURER A: <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTED <br />COMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurence) <br />CLAIMS MADE OCCUR MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN’L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $ <br />PRO-POLICY LOCJECT <br />COMBINED SINGLE LIMIT $(Ea accident)ANY AUTO <br />ALL OWNED AUTOS BODILY INJURY $(Per person)SCHEDULED AUTOS <br />HIRED AUTOS BODILY INJURY $(Per accident)NON-OWNED AUTOS <br />PROPERTY DAMAGE $(Per accident) <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO EA ACC $OTHER THAN <br />AUTO ONLY:AGG $ <br />EACH OCCURRENCE $ <br />OCCUR CLAIMS MADE AGGREGATE $ <br />$ <br />DEDUCTIBLE $ <br />RETENTION $$ <br />WC STATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT $SPECIAL PROVISIONS below <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC # <br />COVERAGES <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2001/08)© ACORD CORPORATION 1988 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE