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DocuSign Envelope ID: 5004353C-17AB-4010-9OB4-B1COAE44672A
<br /> ANN+'rl�Y
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<br /> CERTIFICATE OF INSURANCE
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<br /> r e - T"I#IIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONU—
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<br /> ._.......__ _--- — , AGENT'S NGt, ��C,.E � �
<br /> hIA�fT NDA[DRESSOfAGFNCY BART-FC7�.11 K 1�'(�'6<.IS6 I�i�+CritOU tl.�_G. " ��i �(�MPd�iWY
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<br /> fCliiCilili�r i_I:. @ G: 77;<I -Ff>Gsf' rDlrlbc DX 1, +l, ttor,oy,ln act � IrNY l
<br /> ewa F °'HI INS" "C 1 P4Y
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<br /> �� ' ! ibis certiticafe is isle l for Ir ern�la�lo poses only acrd canffrs
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<br /> no rls�tpts an the certificate bmfdere It dams not a @firrnatleefy or
<br /> J terms androndffions�et he pmlt (1 s)govern
<br /> Meatentl,or otherwise fled It any given sI u ,.
<br /> PIAMF 40 4L 0RESS DE P;V� b iNSUaED negatively amend,e
<br /> 11xl ,rhC156GLNC,fltln tDD�rgc¢'ita:°r16 and conditions of insurance covera+a contained In the pofic ies
<br /> indicated bcluur The
<br /> YNC" the insurance coverage as app
<br /> shown may have been reduced by clarets paid.This certificate of
<br /> tfClfi CTelrhsln E�Irtirpr�I t�lulf insurance dogs not constitute a lwntrart between the Issuing
<br /> Lrurlmr�DIL1 t1,11 ('113I) Insurerisl, authorized reptesentaffve or producer and the
<br /> y I cerfificatt holder. ,,,,�„�, ,, ..�....
<br /> TN16 i5 fta cw"rfi ii�a�p011r,ir�S a51f1dIC$'fo ttl";:hC B�gIR'"} ftlt'rY 7 r J�E.kG3,M c1r�"G'�"X`S,A lorce
<br /> w.a f�5 �r�� f9rr7e'Gh+t the .,�'c"diG1"ritw CS fl''. M1 u.
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<br /> Addl IYFi 061"Ms4iR#AWC� G p�t NS ,,. e G f, 11.4r4.1 f
<br /> e o Pot ICY EACH ULCMJiI6tENCE i
<br /> GEREPAL LIABILITY o17 rr1r�? 6 i r6 14 i I'1/1 i --- - CNIAGG A 4v ENahr $ I Ip �fLI&dp W
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<br /> COMMERCIAL BE14ERAL LIABIL"
<br /> INEDEJGf'Agyl�V S
<br /> CIAMS MADE �L� .
<br /> j OCCUR PERSONA L E AIaY1.YNJLBAI" $ �VX iG1.°:r�1ip
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<br /> PRQGYIfL'y AGNIRE&��1N _ r
<br /> Ga6NE
<br /> xn G G)$wIPBGP AGG S
<br /> C,ENtl'l ASxCRt.CNYTFi l.INalt APPLIES PER:
<br /> _ C i MOJECf C Gw
<br /> _. .. ._ .... .._._ ._,., __..,...._.,_ BoDItY INJORY
<br /> AUTOMOBILE LIABU.JTY (EACH PERSON ""r
<br /> "ANY AD U"lND O3 N1E J A fiJfLV IYfl Y 4Ry
<br /> I OWNED
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<br /> PROPERTY
<br /> . DA4MfEt AI 6E ,$
<br /> HIRED BODILY IN URYAND
<br /> PSDPRTYDAMAGE
<br /> NON-OWNED CotASINEJ S
<br /> 8GAAGI
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<br /> IVCF_ ,S
<br /> EXCESS LIABILITY AG;GtdE TAtE .�
<br /> pCCJIRRENCE
<br /> RETENTION S -
<br /> I- WORKERS COMPENSATION&�� Q 9 5 11I f 128"t 5X � ��i�I"I V i n� BO ILY Arc CIOENV S 1 NMG.�fI,f{lU EACH ACCIC7ENJ'
<br /> EMPLOYERS LIABILITY N9URY 06EASE S I f110j,00POLIG�YUm[T
<br /> BY DISEASE S i 11(1O,(00 VACH Fr�hPwO
<br /> OTHER
<br /> UESC ERATIfJI'SdLOCATIOfJSY1NEHtG.I.ES;rEXG.LU"aIGIIXS 1SEYEffJaPECL IPFC1ISfDfS AOOO BY EID
<br /> MPTI tP
<br /> .
<br /> CANCELIATIOW SHOULD ANY OF THE ABOVE DESCRIBED i'i1L.It iE BE CANCELLED BEFOFaETHE E�i'11TA8�IUXd L1ATFTFIL EC3Fa NCIIf
<br /> EKED IN ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL I'N"SURM the IcO11Cy�ies)must be ehu�G�rSCd.if SDBROO��111 N iS twAI�L�O.subject tXN the
<br /> terms and cnndXtjDns�of the pclilcy,certain p0f Cr eS rTay requ4e an endorsement,A statement On fh6.9 clNrtlf sate oA nct Confer
<br /> rights to the certificate hollder in fieu of sect' r ndOrsrrinentirl
<br /> NAME AND AOOpTESS O CERTIFICATE HOLDER AaDrOWI OMPRE E i.dArY�r:
<br /> I'G711�u�u(;G�p`�XII
<br /> IAII�Fe,ruul+.'NA 2727
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