2018-183-E Emergency Svc - Excellance Ambulance Remount #794

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DocuSign Envelope ID: 890AB1BA- 173D- 46A1- B569- D7AE7E5CA4F3 (gl fr tj AC40R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 8/2/2017 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 CONTACT Cleonie Nathanielsz NAME: JD Fulwiler & Co. Insurance, Inc. PHONE (503)293 -8325 FAX (503)293 -5918 LAIC, No. [YI) _ (Arc, NI,) 5727 SW Macadam Ave ADDRESS cnathanielsz @jdfulwiler.com PO BOX 69508 INSURER(S) AFFORDING COVERAGE NAICN Portland OR 97239 INSURER A .National Fire Insurance of Hartford 20478 INSURED INSURER e:Continental Insurance 35289 EXcellance Inc INSURERC: 453 Lanier Rd INSURER D : MED EXP (Any one person) $ INSURER E : Madison AL 35758 1 INSURER F: rITIrI^A- 11,11 ua000.fIT.17A1 d5t9Af1 RG\ /ICInKI NIIMRFR- vTHIS 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 CONTRACT OR 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 TYPE OF INSURANCE :ADD., SUL3H POLICY NUMBER (MMLDDIYWY MMIODYlYYYY LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - DAMAGE TO RENTED 300,000 A CLAIMS -MADE X OCCUR PREMISES (Ea occurrence) _ $ 6042861810 8/1/2017 8/1/2018 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000 X POLICY PRO- 11 LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 HL R: Employee Benefits $ 1,000,000 SINGLE LIMIT $ Ear aec 1,000,000 AUTOMOBILE LIABILITY dent) %X BODILY INJURY (Per person) $ ANY AUTO A ALL OWNED SCHEDULED 6092861807 8/1/2017 8/1/2018 BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED IfiRO PERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per sccident) Medical oavments $ 5,000 X UMBRELLA L1AB OCCUR EACH OCCURRENCE $ 9, 000, 000 B EXCESS LIAB CLAIMS -MADE AGGREGATE $ 9,000,000 DED X RETENTION$ 10,000 6042861824 8/1/2017 8/1/2018 $ WORKERS COMPENSATION PER ERA AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE 'NIA E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E. L DISEASE - EA EMPLOYEE $ _ IF yes, describe under DESCRIPTION OF OPERATIONS below E l.. DISEASE - POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) P`COTI Cl/"ATC r.ir)i rtrn CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF OF INSURANCE ONLY 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Becky Harding /CLEONI U I VJJJ5 -LU'14 AL.UKU l,UMrL)MA I IUIY. All I I y I W. ICDCI VCU. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) i I ,