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<br /> DocuSign Envelope ID: F9EEB204-AFE5-4984-B49A-37234E3B3DBD
<br /> ..............
<br /> CERTIFICATE OF LIABILITY INSURANCE
<br /> ,. 11IIp12013
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND', EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
<br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(tes) must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsernent. A statement on this certificate does n!ot confer rights to the
<br /> certificate holder In!fieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> MARSH USA,ING NAME: ..........................
<br /> PHONE FAX
<br /> 445 SOUTH SIREET 01c,No,E x1i);.............................. (AIC,No):
<br /> MORRIS I OWN,NJ U1960-6454 E-MAIL
<br /> ADDRE§Si .........................
<br /> IN NE Pfd(S)qf`ORDIING COVE AGE r NAIC#
<br /> 100129 6 719A-SBTI4'04 228 Ras NG0 INSURER A HDI.CxMing Afneri�,@I I osuranoa Gwipany
<br /> INSURED d O ..
<br /> ............
<br /> SlI,MFNS INDUSTRY,INC.INCLUDING ..............I1.........................................
<br /> BUILDING 11,I."CIINOLOGIES DIV00N INSURER C The Chader Oak Fire Insurance Company 25515
<br /> ..........
<br /> 1000 DI ERFIELD PARKWAY
<br /> R D
<br /> BUFFAI-0 GRONJI..,It ..INSURE
<br /> 60089,4513
<br /> ..........I..................
<br /> INSURER E:
<br /> ... .........................
<br /> INSURER F.
<br /> COVERAGES CERTIFICATE NUMBER: NYC 006152385-01 REVISION N�UMBER:
<br /> ...........................................................................
<br /> I HIS IS rO CERTIFY THA]" THE POLICIES OF INSURANCE LISTED,BELOW HAVE BEEN'ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED, NOTW"ASTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERfWICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSNONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> dN SRI Abbilslubg 11-_1111-1-11-1111-11-- POLTOYEFF � 0601 q E xv,
<br /> TYPE OF INSURANCE INSR wvO POLICY NUMBER IMMAHAYM.1m LiMITS
<br /> ............
<br /> A GENERAL LiABIILITY GLD1110105 1010112013 10012014 1,000,000
<br /> b A ONE'TO k tN T E D
<br /> X COMME RCAL GENERA.UAWLITY E,I„�M IS ES(Ea awknence) is
<br /> x Oc'GILIR LIMED 100,000
<br /> CLAIMS-MADE EXI (Any arse IpLysafi) Is
<br /> 1,0G0,0010
<br /> PERSONAL&ADV INJURY I$
<br /> GENERAL AGGREGATE
<br /> GENII,AGGFt.-.GA1ILIMITAPPLIES PER:
<br /> PRODUCTS COMPIOP AGG
<br /> X POLIC;Y
<br /> ILOC
<br /> C<WBINEO SNGLE UMII
<br /> 13 AU 10140011I..E.LIABILITY iTC2,JC&P744U_34A13 I501/2013 10M12014 2,0(@,000
<br /> X ANY AU 10 BODILY WJUIRY(Per porwn) s NIA
<br /> X All()W�JED SMIEDULED BODILY INJURY(PWL 00��dent) $ NIA
<br /> A ifos AUTOS
<br /> NON-OWNE.A.)
<br /> Pw.)PE;kf W'A'GE
<br /> X HIIREDAUTOS x AUTOS War ac-41000), ................... . ....................
<br /> O(,C
<br /> UMBRELLA LIAR OCCUR I EACH OCCURRENCE
<br /> .................
<br /> EXCESS_IAB
<br /> CE AGGREGATF
<br /> CLAMS,MA
<br /> DED RE'TENTION$
<br /> PENSA71ON 1010112013 10MV2014 EX7M�STTI7- 0I HWORKERS COM TC20UB744OL271 1!3(AOS) OR�LIM � ER
<br /> -TORY LIMITS
<br /> ANO EMPLOYERS'LiAVIII-ITY YINI
<br /> i 1,000,000
<br /> ANY R:IROPIalf.-.'R'Ol��)rARTNEFVEXfi(,,UTRVE TRJUB744008313(AZ,MA,OR WI) 10101120�13 10MV2014 $
<br /> 0FRCERMEMBER EXCLUDED? �NrA J.,I,,_EACH ACCIDENT
<br /> (Mandatory In NH) 9 11VVXJIU67440L 33813(OHI&WA) 101011 1'13 10,0112014 E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> fps
<br /> desalbe urxWr
<br /> D RIPTION OF,OPERATIONS below $5000[]!MIT 1$500K SIR L.1..DkSEASE-POLICY UMIT S
<br /> ..............
<br /> DESCRIPTION OF OPERAIIONS I LOCATION'S IVEHICLES (Attach ACORD 101,Addiflonall Remarks Schedute,if more 5pnee Is roquired)
<br /> RE:JOB NO,N/A
<br /> SEE ATTACHED
<br /> ...............................
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Co UN I Y OF ORANG I' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> ASSE[MANAGEMENI SERVICES THE EXPIRATION DATE THEREOF, NO'TICE WILL BE DELIVERED IN
<br /> 600 NC HIGHN AY 86 N ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 10.1-SBOROUGH,NC 2?278
<br /> AUTHORIZED REPRESENTATIVE
<br /> of Marsh USA Inc,
<br /> Manashii Mukherjee
<br /> ............. ......
<br /> 0)1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(201�01015) The ACORD name and logo are registered marks of ACORD
<br />
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