2018-161-E AMS - Excellance Remounting Contract

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DocuSign Envelope ID: D329DEE1- 1083 - 4935- A32C- FCOODAA234AC VIIGIIL1r. JJJVJ 38EXCELLANCE1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 01/1012018 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 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). PRODUCER J Smith Lanier & Co- Huntsville Marsh & McLennan Agency, LLC P. O. Box 6087 Huntsville, AL 35813 -0087 CONTACT NAME: PHONE 256 890 -9000 FAX 256 890 -9070 A/C, No, Ext : A/C, No E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Alabama Self Insured WC Fund INSURED INSURER B: Midwest Employers Casualty 25992 Excellance, Inc. 453 Lanier Road INSURER G MED EXP (Any one person) $ Madison, AL 35758 INSURER D: PERSONAL & ADV INJURY INSURER E GEN'L INSURER F GENERAL AGGREGATE $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ PREMISES Ea occur ante $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY JECT OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /N OFFICER/MEMBER EXCLUDED? F 7N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC10000998002018A POAL129001 01/01/2018 01/01/2018 01/01/2019 01/01/2019 X PTAT TE EERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 11101 Q! G's I l a Pfd\ I am G PJ A NJ R 0 L9 RA AG\I NJ► For Proof of Insurance Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t7 15)KA -7614 ACORD CORPORATION_ All rights reserved ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3770269/M3770267 PZR