Medallion Athletic Products - Laserfiche WebLink

Home Browse Search

----I-1 MEDAL-1 OP ID: PJ "�°RO CERTIFICATE OF LIABILITY INSURANCE DATE 12/03/12 12/03/12 . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS allCERTIFICATE 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(les) must 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). PRODUCER Associated Ins Agency 828-328-5671 EECT Paula M.Johnson CIC CPIW FAx P O Box 3858 (630 4th St SW) 828-3285166 IAA:.No En1.828-3285671 I lac,No):828-328-6166 Hickory,NC 28603 ADDRESS:paulajohnson @broomeins.com David Neal-Original Renewal INSURERIS)AFFORDING COVERAGE NAIC P INSURER A:New Hampshire Insurance Co INSURED Medallion Athletic Products INSURER e:The Cincinnati Specialty Inc. INSURERc:Auto Owners Insurance 18988 Matt Broughton 150 River Park Road INSURER D:Peerless Insurance Company 24198 Mooresville, NC 28117 INSURER E: INSURER F: COVERAGES CERTIFICATE 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. LTRRI TYPE OF INSURANCE NSR*VDI POLICY NUMBER I(M°M)DDDIYm IIMM,DD(YYW1 I UNITS GENERAL LIABOJTY I EACH OCCURRENCE I S 1,000,000 B X COMMERCIAL GENERALUABILITY X CSU0009670 03/15/12 03/15/13 DAMAGETORENTED I PREMISES(Ea NTED el I2 100,000 I CU-OAS-MADE © OCCUR MED ExP(Any one persm) I5 1,000 X Blanket Al PERSONALbAW INJURY IS 1,000,000 X E2500 Dedt GENERAL AGGREGATE I5 - 2,000,000 GEM.AGGREGATE UNIT APPUES PER: PRODUCTS•COMP/OP AGG S 2,000,000 I POLICY 11L 1 7a n LOC 15 AUTOMOBILE UABILTTY (COMBI DSINGLE UMIT I5 1,000,000 C X ANV AUTO 4$14$21701 06/18/12 06/18/13 BODILY INJURY(Per person) I S ALL O.YNED SCHEDULED BODILY INJURY(Per a�dem) S AUTOS AUTOS HIRED AUTOS IAhON-0VMED - PROPERTY DAMAGE S AUTOS (Per ear/dent) IS I UMBRELLA UAB _ OCCUR I EACH OCCURRENCE I S —I EXCESS UAB CLAIMS-MADE AGGREGATE I S DED I I RETENTIONS I Ip I S WORKERS D EMPLOYERS'WBNTY YIN I I X ITORYUM 5 I I FR I A ANY PROPRIETOR/PARTNERIEXECUTIVE �C004963057 3A STATES: 06/18/12 03/15/13 E.L.EACH ACCIDENT 15 1,000,000 OFFCER/MEMBER EXCLUDED? © N I A (Mandatory In NH) NC,GA,MD,SC,AL,FL E.L.DISEASE-EA EMPLOYEd S 1,000,000 I/rte.dHmbe uger DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT IS 1,000,000 D Equipment Floater IM8121941 03/07/12 03/07/13 Leased Eq 100,000 • $500 Dedt DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addt anal Rs.wks Schedule.II more epees Is reguIred) WC EXCLUDED OFFICERS: MATTHEW E. BROUGHTON 6 JOELLE BROUGHTON CERTIFICATE HOLDER CANCELLATION CSI180S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Sunny Isles Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Office of the City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 18070 Collins Avenue AUTNORIgD REPRESENTATIVE Sunny Isles Beach,FL 33160 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD