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DocuSign Envelope ID: EEDCD3FB-CO27-4E00-8COB-02929E8F4COB <br /> DATE(MM/DOPIYYYY] <br /> CERTIFICATE Or LIABILITY INSURANCE <br /> PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br /> t�rg�rxlnrunnceAge ry,lrc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 27301 PJirta R¢al Site 7i0 HOLDER. THIS CERTIFICATE ODES NOT AMMEND, EXTEND OR <br /> N1'SS'm 55e;o,fA97s91• - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br /> R77.-038.7;59 <br /> INSURERS AFFORDING COVERAGE, NRIC B <br /> INSURED 1ti5UAFR A:Ph'fadc'PNaledem�i iasvrsnte CnT an 1&1S9 <br /> Sitar khn INSURER S: <br /> dF3:US Y7e Ktaon Do Cente,,int- IN SUA£RC: <br /> TS20I Botx Garden In IN SURER O: <br /> ,,..ha m,TIC 277D7-EE00 <br /> INSURf0.E: <br /> COVERAGES <br /> TILE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE tNSUREO NAMED ABOVE FORTH€POLICY PERIOD INDICATED. NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB)€CT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INSR AO WC POTICYEEFECAvE POLICYaFiRAYION <br /> LTR 11690 'TYPE OfINSURANCE POLICY NUMBER DATE(W.4jDDJ1)YY) DATEP%W/ODJYe LIMITS <br /> A % GENERAL tMILITY P!I?z439TP.3-0,5 63IOSJT015 OFJOSITOIS EACHOCCUAEHCE S1,DM.00d <br /> DANAGE To 13EUILOT <br /> % COS1FAtA0At6j2jERALUA811NY F E1AE$Ito ocarr me $L <br /> T'FL.11ATk1S).4AOE 1 OCCOA MEDW(A eolar4non)FE5519.1M VAiTUTY PERSONALBANT'TIUAY SISO)MO <br /> GENERALAGGREGATE $3100.000 <br /> 6011AWk9 GATEiU.11TAFFUESFIR: ERODUCTS—COMPIO?AGG $T,C00,0Y3 <br /> X FOuq PAOI(a LOC <br /> AUTOMOBILE LIASIUTY C41,l81 II(O SINGLE 11 v IT <br /> �. AltYAUTO JEAacc'dent) <br /> Alt OliWI FO AUTO$ OOD:LY IUIUAY <br /> SCHEDULED AUTOS LPe r Fenvn} <br /> III REDAUTOS 000U UHt1RY <br /> NONOWNEDAUTUS LPera delt) <br /> PAOPERTYDWAG£ <br /> (Per accrdtat) <br /> OA-CAGE VAOIUIY AUTO ONLY—fA AEOOEEFT <br /> AIIYAUTO OTHER THAN EA ACC <br /> AUTOONLY; AGG <br /> t3LCf SS I UMORELIA V AOIUTY EACII OCCUR[NCE <br /> OCCUR CLAIMS MADE AGGREGATE <br /> DEDUCT]BLE <br /> -.— A£Tf NilO1F <br /> Lw WPtOYER3'VABR1 Y 14 fiORYUldrtS ER <br /> ANY P�OrAIFTORAgTITEA1EMfCUT1`lE }� E.LERCHACG'1EpT <br /> OFFICER MEMBER CL DTD <br /> [F.!rndalory IA NNJ E.L DISEASE—FA AMFLOYEC <br /> If s descnb 0r,er , <br /> SPECfAi P,70VdVwls ktlws £-L-DISEASE—F QU4Y U h1I <br /> OTHER <br /> OESCRIPNRN OF❑PERATIOtiS j LOCATfONS(Vf N:CUS j E%CfUStD$3 ADDED BY EtNDOR$Et,$ElfTISPECfAL PAOVIS!ONS <br /> ItL1urder1L00d and ay14e3 that Ike fo4o&fng eut:ty I1 added a1 an a"'lro'lal Lr and ninned MulFd e%CEPt that Illb'fwres-i't7r&froT the a$1:tTonaINured'S sole <br /> • a <br /> CCRTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF TILE ABOVE DESCRIO£0 POLICIES DE CANCELLED REM THE 1MRATI0I1 DATE <br /> OR 19e CourlyALIA:81,11;M311gefrenl THEREOF,THE ISSUIh'0 INSURER%ALL ENDEAVOR 10 T,1AIL LO DAYS VIRIT101 NOTICE TO TILE <br /> 200 5 CZWM154 FO Bac 818 L CERTIFICATE HOLOER NAMEO TO THE LEFT,BUT FA)LURE 70 DQ 50 SITAIL 1R1POSf HU O BUGA710N OR <br /> Lfifitaro�Eh,Ne 27178- LIABILITY OF ANY KOID UPON THE 1NSURIR,ITS AGENTS OR REPRESEITTATIVES, <br /> AUTHORaIEO REP,?ESETTTATWE <br /> ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION,All rights reserved, <br /> The ACORD name and logo are reglstereJ marks of ACORD <br />