ACORD_Form_20250307-113738.pdf
PDF 25 MB Posted
- Attached to
- Master Agreement AZ|CTR062454
- Contract number
- CTR062454
- Issued by
- Arizona
About this file
This document is an ACORD Certificate of Liability Insurance for End 2 End Communications LLC (DBA: End 2 End Technologies KS Lease Vehicle Company LLC), issued by Strong Tower Insurance Group Inc. The certificate involves multiple insurance providers, including The Charter Oak Fire Insurance Company and Travelers Property Casualty Company of America, and is primarily associated with the State of Arizona Department of Administration and State of Arizona Procurement Office. The certificate covers various locations including offices in Gilbert, AZ, Phoenix, AZ, and a Flagstaff office.
The insurance coverage is for a Communications Cabling Systems contract (Contract #CTR62454, Solicitation #BPM004541) with policy periods from 06/01/2024 to 06/01/2025. The policies include multiple coverage types with significant limits: a $10,000,000 umbrella policy, $1,000,000 in general liability, professional errors and omissions coverage, cyber and crime insurance, and leased equipment coverage. The certificate provides additional insured status for the State of Arizona and includes provisions for waiver of subrogation and primary non-contributory endorsements. Key coverage amounts include a Professional Liability Errors & Omissions (PLEO) limit of $1,000,000, Crime coverage of $1,500,000, and Leased Rented Equipment coverage of $50,000.
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Text version
05/24/2024
Strong Tower Insurance Group Inc 3325 E Baseline Rd
Gilbert AZ 85234-2633
Strong Tower Insurance Group Inc
(480) 926-9011 (877) 464-6442 jill@strongtowerig.com
End 2 End Communications LLC, DBA: End 2 End Technologies KS Lease Vehicle Company LLC 1715 W Sunrise Blvd Ste A Gilbert AZ 85233-5032
The Charter Oak Fire Insurance Company 25615 Travelers Property Casualty Company of America 36161 Travelers Casualty & Surety Company of America 31194
24-25
A
Limited Pollution
630-5W69849A 06/01/2024 06/01/2025
1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000
Limited Pollution ea/agg 1,000,000
B 810-5W615522-A 06/01/2024 06/01/2025
1,000,000
B 10,000
CUP-7W677532 06/01/2024 06/01/2025
10,000,000 10,000,000
C N UB-5W706929 06/01/2024 06/01/2025
1,000,000 1,000,000 1,000,000
B C Professional EO; Cyber, Crime IM Leased Rented Equipment ZPL-91N6629A; 630-5W69849A 06/01/2024 06/01/2025
PLEO Limit $1,000,000
CRIME $1,500,000
LEASED RENTED EQUI $50,000
1110 W Washington - TI21067, Data Line Pull- day before Furniture Tear Down - Automatic Additional Insured Status for US Bank National Association Trust as Trustee for the State of Arizona (Property Owner) and Lincoln Property Company Commercial, Inc. (Managing Agent) when required by a written contract per attached endorsement.
Automatic status of Waiver of Subrogation, Primary Non-Contributory wording/endorsement and Ongoing Operations when required by a written contract per the attached endorsement.
State of Arizona Dep of Admin | Gen Services Div 1400 W Washington Ste B200
Phoenix AZ 85007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
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.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
JillKriens Typewritten Text Policy 630-5W69849A
Policy 810-5W615522
Policy 810-5W615522
JillKriens Typewritten Text
3325 E Baseline Rd
Gilbert AZ 85234-2633
Strong Tower Insurance Group Inc
(480) 926-9011 (877) 464-6442 jill@strongtowerig.com
End 2 End Communications LLC, DBA: End 2 End Technologies KS Lease Vehicle Company LLC 1715 W Sunrise Blvd Ste A Gilbert AZ 85233-5032
The Charter Oak Fire Insurance Company 25615 Travelers Property Casualty Company of America 36161 Travelers Casualty & Surety Company of America 31194
24-25
A
Limited Pollution
Y 630-5W69849A 06/01/2024 06/01/2025
1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000
Limited Pollution ea/agg 1,000,000
B Y 810-5W615522-A 06/01/2024 06/01/2025
1,000,000
B 10,000
CUP-7W677532 06/01/2024 06/01/2025
10,000,000 10,000,000
C N UB-5W706929 06/01/2024 06/01/2025
1,000,000 1,000,000 1,000,000
B C Professional EO; Cyber, Crime IM Leased Rented Equipment ZPL-91N6629A; 630-5W69849A 06/01/2024 06/01/2025
PLEO Limit $1,000,000
CRIME $1,500,000
LEASED RENTED EQUI $50,000
ADOT Flagstaff Office 1959 S Woodlands Village Blvd
State of Arizona Department of Transpotation, VP Cinema LLC, VP Flagstaff P3 LLC, Vintage Development LLC, and Wespac Construction Inc their agents representatives employees or subsidiaries are additional insured per the attached policy forms.
State of Arizona 100 N 15th Ave Ste 201
Phoenix AZ 85007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
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.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
Policy 810-5W615522
JillKriens Typewritten Text
3325 E Baseline Rd
Gilbert AZ 85234-2633
Strong Tower Insurance Group Inc
(480) 926-9011 (877) 464-6442 jill@strongtowerig.com
End 2 End Communications LLC, DBA: End 2 End Technologies KS Lease Vehicle Company LLC 1715 W Sunrise Blvd Ste A Gilbert AZ 85233-5032
The Charter Oak Fire Insurance Company 25615 Travelers Property Casualty Company of America 36161 Travelers Casualty & Surety Company of America 31194
24-25
A
Limited Pollution
Y 630-5W69849A 06/01/2024 06/01/2025
1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000
Limited Pollution ea/agg 1,000,000
B Y 810-5W615522-A 06/01/2024 06/01/2025
1,000,000
B 10,000
CUP-7W677532 06/01/2024 06/01/2025
10,000,000 10,000,000
C N UB-5W706929 06/01/2024 06/01/2025
1,000,000 1,000,000 1,000,000
B C Professional EO; Cyber, Crime IM Leased Rented Equipment ZPL-91N6629A; 630-5W69849A 06/01/2024 06/01/2025
PLEO Limit $1,000,000
CRIME $1,500,000
LEASED RENTED EQUI $50,000
Contract #:CTR62454 | Solicitation # BPM004541 | Communications Cabling Systems
Automatic Additional Insured Status for the State of Arizona when required by a written contract per attached endorsement.
Automatic status of Waiver of Subrogation, Primary Non-Contributory wording/endorsement and Ongoing Operations for the State of Arizona when required by a written contract per the attached endorsement
State of Arizona Procurement Office, 100 N 15th Ave Ste 201 Phoenix AZ 85007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
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.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
Policy 810-5W615522
JillKriens Typewritten Text
3325 E Baseline Rd
Gilbert AZ 85234-2633
Strong Tower Insurance Group Inc
(480) 926-9011 (877) 464-6442 jill@strongtowerig.com
End 2 End Communications LLC, DBA: End 2 End Technologies KS Lease Vehicle Company LLC 1715 W Sunrise Blvd Ste A Gilbert AZ 85233-5032
The Charter Oak Fire Insurance Company 25615 Travelers Property Casualty Company of America 36161 Travelers Casualty & Surety Company of America 31194
24-25
A
Limited Pollution
630-5W69849A 06/01/2024 06/01/2025
1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000
Limited Pollution ea/agg 1,000,000
B 810-5W615522-A 06/01/2024 06/01/2025
1,000,000
B 10,000
CUP-7W677532 06/01/2024 06/01/2025
10,000,000 10,000,000
C N UB-5W706929 06/01/2024 06/01/2025
1,000,000 1,000,000 1,000,000
B C Professional EO; Cyber, Crime IM Leased Rented Equipment ZPL-91N6629A; 630-5W69849A 06/01/2024 06/01/2025
PLEO Limit $1,000,000
CRIME $1,500,000
LEASED RENTED EQUI $50,000
State of Arizona is additional insured per the attached policy forms.
State of Arizona Procurement Office, 100 N 15th Ave Ste 201 Phoenix AZ 85007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 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.
OTHER:
(Per accident)
(Ea accident)
N / A
SUBR
WVD
ADDL
INSD
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.
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
Policy 810-5W615522
JillKriens Typewritten Text
File details come from the government source that posted it. Updated .