|
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />")
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />)
<br />
<br />......--,
<br />
<br />ACORD- CERTIFICA TE OF LIABILITY INSURANCE r DAlE IWM DO-,YYVYI
<br />~ 09- 22 -2011
<br />THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOfol THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVelY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. TI-*S CERTIRCATf:OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI. AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CmTIACATE HOLDER.
<br />IMPORTANT: If the certlflcat. ho<<Ier Is an AODITIONAlINSURED, the poicyliesJ mUsl be enoorsoo. II SUBROGATlONIS WAIVED, subject to
<br />the terms and cortditionsof the policy, certan poIici&9 mey require Bfl enoorsemeflt. A stalemenlon this certificate does not confer rights 10 the
<br />certifiCllte holder in lieu of such endorsementlsl.
<br />~ODUC.ER ~XMr\,o'
<br />USI INSURANCE SERVICES LLC/PHS PHONt (866}467-8730 . fAA (877) 538-852E
<br />226144 P: (866)467-8730 F: (877}538-8526 (A"C. No E.l(r): ~,''-C, I-io):
<br />,'~_'l!J,
<br />PO BOX 29611 AOOR';S s,
<br />CHARLOTTE Ne 28229 eUSTQMEHHH:
<br /> 'NSUR';R'Sl AFFOROING C OVEHAGE ; NAIC'
<br />INSUAfO INSL'RER A, Ha L-t fOl-d I ns Co of the Southeast
<br />SAVINO & MILLER DESIGN STUDIO INSURERS: Twin City Fire Ins Co
<br />12345 N,E. 6TH AVE, STE A IN5URE.>1 C :
<br />tUANI FL 33161 'NSURER 0 :
<br /> INSURER E :
<br /> INSURER F :
<br />
<br />COVERAGES
<br />
<br />CERTifICATE NUMBER:
<br />
<br />REVISION NUMBER:
<br />
<br />I THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTEO BELOW HAVE BEHI ISSUED TO TIlE INSUQEO NAMED ABOVE FOR THt POLICY PERIOD
<br />'tWICATED. NOWlflTHSTANDING ANY REQUIREMENT. TERM OR CONDrrrON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CtRTlFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AffORDED BY THE POLICIES DESCRIBED HEREllJ 'S SUBJECT TO All THE TERMS.
<br />EXCLUSIDrIS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVf BEEN REOUCEO BY PAtD CLAIMS.
<br />',\5,:," TYI'f- OF III$UAANCE ,lfSR WYO POUCY NUMBER 11,r,;;~o~y~';tVJ lrlil:to.'/'{,';'j
<br />~ERAlllAIIl.ITY I '1 i
<br />
<br />COMMERCIAL GENERAL llAB4l1rY
<br />-----:-- CLAIMS.MADE iXl OCCUR I
<br />A x-General Liab 21 SBA LF5961
<br />
<br />;
<br />GE....l AGGREGATE UM,T APPLIES PER: i
<br />I POLICY: P,i{}j-: X IlOC :
<br />AUT<!MOIIU UAllltTY i :
<br />~
<br />~ ANV AUTO i
<br />I All OWNED AUTOS . i
<br />. : seHEOUlEO AlJTOS '
<br />A-
<br />..x "'REO AUTOS
<br />L NON.O",,"W AlJTOS
<br />
<br />lIMITS
<br />
<br /><.~CH OCCURRENCE . $ 2, 000 , 000
<br />P.~EM~5tS ',~,"~'~~".) $ 3 0 0 , 0 0 0
<br />
<br />i ...EO ~XP !Any ~ p...or,l ,$ 10, 000
<br />! 08/28'/2011 flS/28/2012 ;>mSONAl ~ AOV:NJURY $ 2,000,000
<br />i G<NERAl ".GG"IEGAH , 4 , 0 00, 000
<br />PflOOUCIS. CO'.'POP AGO!' 4,000,000
<br />: $
<br />
<br />co....,e. r.:EO $INGLf liP/.:T
<br />IEo! .....:t.de..'U~
<br />
<br />'2,000,000
<br />$
<br />
<br />. BODILY INJURY I;>~r ,"~~$-:rt)
<br />
<br />BODILY IN~V::r'l' .:P!t hXid-!'ntl. $
<br />
<br />21 SBA LF5961
<br />
<br />i PROPERT'" OA.'\tAGE
<br />: 08/28/2011. oe 128/2 012. IPtt l!l(;Ci1f'f'l'l1
<br />
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />Ol:t
<br />
<br />U...IAEUA UAI
<br />
<br />u OCCU~ ;
<br />I I ClAlMS,MAOE!
<br />
<br />. E'-Cl' oceURR,NCE
<br />AGGREGATe
<br />
<br />I
<br />I
<br />!
<br />
<br />I
<br />i
<br />121
<br />
<br />EllC<SS UA9
<br />
<br />_; OEOUenSLE
<br />
<br />! RETENTlON $
<br />WORKERS COIJI_SATIOr<
<br />AND EMn.OVERS' UABIUTY Y IN
<br />ANY PflOPR'E TO A-'PAA1NER.<XECIITIVEU H I AI
<br />B OHiCEA-'MEMBER.El(ClUOEO?
<br />rMIH1dB'DI J In Nf-iJ
<br />I~ ve:t.. deS(:,ibt l..mele.: .
<br />DlSCRlPTION OF O?ERATlO~S below
<br />I I
<br />, I
<br />
<br />: _~. {6ij~l,~.~s
<br />
<br />WEC ZS4648
<br />
<br />I
<br />: 11/07/2011 1L/07/2012
<br />
<br />u. ~"C"'A(;CI):NT $ 1,000 1000
<br />E.l. OISEASE . EA tr~;>"OYE: $ 1, 000 I 000
<br />t.t. DISfASE. POLICY lI/bf' $ 1,000,000
<br />
<br />OESCRI'T~H O:F: OPERATIONS J LOCATJOrtS I VEHIClES [Att6Ch ACORD 101. AddtiOOfll FteItWQ SchedJle-.lIlTlOfe- 'pbC8.. rerpUedt
<br />
<br />Those usual to the Insured's Operations.
<br />
<br />CEflTlFICATE HOLDER
<br />
<br />CAN CELLA liON
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCelLED
<br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />DElIVERED IN ACCORDANCE WITH THE POLlCY PROVISIONS.
<br />AU'HORt~ESENT...nvE _ ~ '
<br />
<br />Leatzow Insurance
<br />~~n, M ~~hm C~ C~p. ~no
<br />
<br />Ii:~\'jl.l..;.~n I r.liItI:I."l['I,~!m1t'il!l :~;[..ii Ji'..l!"'l!!!'l!1
<br />
<br />12~
<br />
|