COI_-_We_Care_Home_LLC_Redacted.pdf

listed herein by policy number(s).

Select one of the following:

A request has been submitted to add the additional interest described below to the policy(ies)

The additional interest described below has been added to the policy(ies) listed herein by policy number(s).

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

FINANCEDVEHICLE / EQUIPMENT INTEREST:

LENDER'S LOSS PAYABLE

LOSS PAYEEADDITIONAL INSURED

DESCRIPTION OF THE ADDITIONAL INTERESTLEASED

ADDITIONAL INTEREST

NAME AND ADDRESS OF ADDITIONAL INTEREST

LOAN / LEASE NUMBER

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 form is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose.

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

INSURER(S) AFFORDING COVERAGE NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

CUSTOMER ID #:

PRODUCER

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

CLAIMS MADE

OCCURRENCE

GENERAL LIABILITY

$EACH OCCURRENCE

GENERAL AGGREGATE

VEHICLE LIABILITY COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE

DATE (MM/DD/YYYY)

SERIAL NUMBERDESCRIPTION

BODY TYPEMAKE / MANUFACTURER VEHICLE IDENTIFICATION NUMBERMODELYEAR

DESCRIPTION OF VEHICLE OR EQUIPMENT

THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S) 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 POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO

ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES).

ADD'L

INSRD

INSR

LTR

POLICY EXPIRATION

DATE (MM/DD/YYYY)

POLICY EFFECTIVE

DATE (MM/DD/YYYY)TYPE OF INSURANCE POLICY NUMBER LIMITS

REMARKS (INCLUDING SPECIAL CONDITIONS / OTHER COVERAGES) (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

ACORD 23 (2016/03) The ACORD name and logo are registered marks of ACORD

© 1997-2015 ACORD CORPORATION. All rights reserved.

DED$

LIMIT$

DED$

LIMIT$

STATED AMT

AGREED AMTACV

DED$

LIMIT$

RC

SPECIAL

BROADBASIC

EQUIPMENT

LOSS

PAYEE

INSR

LTR

STATED AMT

AGREED AMTACV

VEH OTC

LIMITS / DEDUCTIBLE

STATED AMT

AGREED AMTACV

POLICY EXPIRATION

DATE (MM/DD/YYYY)

POLICY EFFECTIVE

DATE (MM/DD/YYYY)POLICY NUMBER

VEH COMP

TYPE OF INSURANCE

VEH COLLISION LOSS

VEHICLE / EQUIPMENT VALUE

We Care Home LLC

1,000,000.00UM/UIM - BI ONLY

1,000,000.00

01/23/202501/23/202401APM043275-01

A

Berkshire Hathaway Homestate Companies jaxson@toroins.com

(602) 345-0360

Jaxson Hodges

We Care Home

85204AZMesa

Ste 212

931 E Southern Ave

Toro Insurance Group

1/24/2024