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DocuSign Envelope ID:29F350EB-C553-4EEB-BD97-898B3775EE03 <br /> RACAN-1 OP ID:PON <br /> +e✓+eC ' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYYY) <br /> 01/30/2015 <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(les)must be endorsed. If SUBROGATION IS WAIVED,sub*t to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACr Patrick O'Neill <br /> Robert C.Bill Associates,Inc NAME: <br /> 160 Broadhollow Road Suite 307 P He f.631-424-3300 No,:631-427-0105 <br /> Melville,NY 11747 IL <br /> ADDRESS;ponei ll @robertcbillassociates.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA;Zurich American Insurance Co. 27855 <br /> INSURED Racanelli Construction South, <br /> Inc. INSURER B; <br /> 1895 Walt Whitman Road,Ste 1 INSURER C: <br /> Meivllle,NY 11747 INSURER D: <br /> INSURER E <br /> INSURERF; <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ILTR TYPE OF INSURANCE POLICY EFF POLICY E INSID D POLICY NUMBER MMIDDlYYYY MMIDDlYYI'Y UMfTS <br /> A . X COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE ; 2,000,00 <br /> CLAIMS-MADE T OCCUR X ' X GL06918594-09 01/31/2015 01/31/2016 PREMISES R occurrence $ 300,00 <br /> M ED EXP(Any one person) $ 10,0 <br /> PERSONAL BADVINJURY S 2,000,00 <br /> GEN'LAGGREGA7E LIMIT APPLIES PER: GENERAL AGGREGATE ; 4,000,00 <br /> POLICY F-1 JECT LOC <br /> PRODUCTS-COMP/OP AGG ; 4,000,00 <br /> OTHER: Emp Ben, $ 1,000,00 <br /> AUTOMOBILE LIABILITY COMB EpSINGLELIMIT $ <br /> Ea acddenl <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS ANDWOMED. PROPERTYDAMAG <br /> Peracadern $ <br /> 5 <br /> X UMBRELLA LIAB L�x OCCUR <br /> A EXCESS LIAR CLAIMS-MADE X X UCS918559-09 01/31/2015 01/31/2016 AGGREG OCCURRENCE $ 26,000,06 <br /> •DED X RETENTIONS 10,000 <br /> WORMERS COMPENSATION $ <br /> AND EMPLOYERS'LIABILITY X STATUTE ER <br /> A ANY PROPRIETOR/PARTNERIEXECLMVE <br /> YIN X C5918595-09 01/3112015 01/31/2016 E•L,EACH ACCIDENT S 1,000,00 <br /> OFFICER/MEMBER EXCLUDED? �[N/A <br /> (Mandatory lnNH) ELDISEASE-EAEMPLOYE ; 1,000,00 <br /> UIfyyas describeunder <br /> SG�RIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SAMPLEI <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> SAMPLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD <br />