Debra_s_Place-Auto_Insurance_05122026_Redacted.pdf

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR

LTR

ADDL

INSD

SUBR

WVDTYPE OF INSURANCE

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

OTHER:

PRO-

JECT LOC

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

HIRED

AUTOS ONLY

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANYPROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBEREXCLUDED?

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

Y/N

N / A

POLICY NUMBER

POLICY EFF POLICY EXP

(MM/DD/YYYY) (MM/DD/YYYY) LIMITS

EACH OCCURRENCE

DAMAGE TO RENTED

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

PREMISES (Ea occurrence)

COMBINED SINGLE LIMIT

PROPERTY DAMAGE

BODILY INJURY (Per person)

(Ea accident)

BODILY INJURY (Per accident)

AGGREGATE

EACH OCCURRENCE

E.L. EACH ACCIDENT

INSURED

$E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

PER

STATUTE

OTH-

ER

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

CERTIFICATE HOLDER CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

© 1988-2015 ACORD CORPORATION. All rights reserved.

(Per accident)

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.

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 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.

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

progressivecommercial@email.progressive.com

05/26/2025

1-800-444-4487

DEBRA'S PLACE DBA: DEBRA'S PLACE

Progressive Commercial Lines Customer and Agent Servicing

898758647393805539D052625T135201

Bridgepoint Insurance Solutions

61 WOLFE CANYON ROAD, KENTFIELD, CA 94904

United Financial Casualty Company 11770

A X 02113369N N 05/12/2025 05/12/2026

1,000,000

A 02113369N N 05/12/2025 05/12/2026

See ACORD 101 for additional coverage details. $

Bridgepoint Insurance Solutions

02113369

United Financial Casualty Company 11770

05/12/2025

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

NAMED INSURED

EFFECTIVE DATE:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance

1 1

Additional Coverages Insurance coverage(s) Limits…………………………………………………………………………………………………………………………………………………………………………………… Uninsured Motorist Bodily Injury $1,000,000 Combined Single Limit …………………………………………………………………………………………………………………………………………………………………………………… Underinsured Motorist Bodily Injury $1,000,000 Combined Single Limit

Description of Location/Vehicles/Special Items Scheduled autos only

2017 DODGE 2C4RDGCG1HR861556GRAND CARAVAN

Collision $500 Ded

Comprehensive $500 Ded

Medical Payments $1,000 each person

Rental Reimbursement $30 Per Day ($900 Max)

Roadside Assistance Selected w/$0 Ded

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.