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H.A. CONTRACTING CORPFortun Insurance, LLC <br />25 Certificate of Liability Insurance: Notes <br />Additional Coverage: <br />Professional Liability - Carrier F (Indian Harbor) <br />Policy #ANE5425979.24 <br />Effective date: 03/26/2024 <br />Expiration date: 03/26/2025 <br />Occurrence Limit: $1,000,000 <br />Self Insured Retention: $5,000 <br />Aggregate Limit: $2,000,000 <br />Cyber Liability - QBE Specialty Ins. NAIC #11515 <br />Policy #CEL-P001-47556302313-00 <br />Effective date: 09/25/2024 <br />Expiration date: 09/25/2025 <br />Occurrence Limit: $2,000,000 <br />Aggregate Limit: $2,000,000 <br />Self Insured Retention: $5,000 <br />Installation Liability- Scottsdale Insurance Company NAIC #41297 <br />Effective date: 08/28/2024 <br />Expiration date: 08/29/2025 <br />Occurrence Limit: $175,000 <br />If required by written contract: <br />Additional insured on the general liability is provided as per CG2010 12-19 and CG2037 12-19, waiver of subrogation as per CG2404 12-19 and <br />primary/noncontributory coverage as per CG0001 04-13. <br />Additional insured on the automobile liability is provided per CA 00044 00, waiver of subrogation as per CA0443 1120 and primary/noncontributory <br />coverage as per CA0001. <br />Waiver of subrogation on the workers' compensation is provided as per WC000313. <br />Any endorsement or form more specific to an additional insured will supersede the above forms. <br />Umbrella follows form. <br />Applicable to all: <br />The policy provisions and/or endorsements form part of the policies of insurance represented by this proof of insurance. The terms contained in the <br />policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed are <br />available by emailing, amy.mencia@fortuninsurance.com and requesting same. <br />ACORD 101 (2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />© 2008 ACORD CORPORATION. All rights reserved. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: FORM TITLE: <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSURED <br />EFFECTIVE DATE: <br /> <br />3HU6FKHGXOH <br />6HHDWWDFKHG <br />6HHDWWDFKHG 6HHDWWDFKHG