COI_10-28-24.pdf

1001486 2005 155279 205 01-19-2023

INSR

LTR TYPE OF INSURANCE

ADD

INSD

SUB

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

A

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

N N 91-E9-P810-9 10/28/2023 10/28/2024

EACH OCCURRENCE 1,000,000$

DAMAGE TO RENTED

PREMISES (Ea occurrence) 300,000$

MED EXP (Any one person) 5,000$

PERSONAL & ADV INJURY 1,000,000$

GENERAL AGGREGATE 2,000,000$

PRODUCTS - COMP/OP AGG 2,000,000$

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

COMBINED SINGLE LIMIT

(Ea accident) $

BODILY INJURY (Per person) $

BODILY INJURY (Per accident) $

PROPERTY DAMAGE

(Per accident) $

A

UMBRELLA LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION 10,000$

N/A 91-GU-X507-8 05/17/2024 05/17/2025

EACH OCCURRENCE 1,000,000$

AGGREGATE 1,000,000$

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER $

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT $

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

CANCELLATION

AUTHORIZED REPRESENTATIVE

05/23/2024This form was system-generated on .

E-MAIL

ADDRESS: anthony.thuan.e3vl@statefarm.com

CONTACT

NAME: Anthony Thuan

PHONE

(A/C, No, Ext): 706-955-8475 FAX

(A/C, No):

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : State Farm Fire and Casualty Company 25143

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

PRODUCER

INSURED

Anthony Thuan 3228 Washington Road

Augusta GA 30907

ADVANCED COVERT TECHNOLOGY INC

PO BOX 3234

EVANS GA 308090090

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.

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.

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

05/23/2024

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

ARIZONA DEPARTMENT OF PUBLIC SAFETY

2102 W ENCANTO BLVD

PHOENIX AZ 85009

The ACORD name and logo are registered marks of ACORD