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The ACORD name and logo are registered marks of ACORD <br />CERTIFICATE HOLDER <br />© 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) <br />AUTHORIZED REPRESENTATIVE <br />CANCELLATION <br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />LOCJECTPRO-POLICY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OCCURCLAIMS-MADE <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurrence)$DAMAGE TO RENTED <br />EACH OCCURRENCE$ <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GENERAL AGGREGATE$ <br />PRODUCTS - COMP/OP AGG$ <br />$RETENTIONDED <br />CLAIMS-MADE <br />OCCUR <br />$ <br />AGGREGATE$ <br />EACH OCCURRENCE$UMBRELLA LIAB <br />EXCESS LIAB <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS <br />PERSTATUTE OTH-ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />$ <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />(Mandatory in NH) <br />OFFICER/MEMBER EXCLUDED? <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNEDSCHEDULED <br />HIRED AUTOS NON-OWNEDAUTOSAUTOS <br />AUTOS <br />COMBINED SINGLE LIMIT <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE $ <br />$ <br />$ <br />$ <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 />INSD <br />ADDL <br />WVD <br />SUBR <br />N / A <br />$ <br />$ <br />(Ea accident) <br />(Per accident) <br />OTHER: <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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject 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 />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />INSURED <br />PHONE(A/C, No, Ext): <br />PRODUCER <br />ADDRESS:E-MAIL <br />FAX(A/C, No): <br />CONTACTNAME: <br />NAIC # <br />INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />INSURER(S) AFFORDING COVERAGE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br /> <br />$VVXUHG3DUWQHUVRI1RUWK&DUROLQD <br />)DOOVRI1HXVH5RDG6XLWH <br />5DOHLJK1& <br />6HOHFW%XVLQHVV8QLW <br /> <br />VEXVHUYLFHQF#DVVXUHGSDUWQHUVFRP <br />%HUNVKLUH+DWKDZD\,QVXUDQFH*URXS <br />%,*%527%XVLQHVV)LUVW,QVXUDQFH&R %LJ%URWKHUV%LJ6LVWHUVRIWK <br />$YLDWLRQ3NZ\6WH <br />0RUULVYLOOH1& <br />%HUNVKLUH+DWKDZD\6SHFLDOW\,QVXUDQFH&RPSDQ\ <br /> <br />$; <br />; <br /> <br /> <br /> <br />; <br />63. <br /> <br />& <br />;; <br />5:6 <br />%; <br /> <br /> <br /> <br />$3URSHUW\ <br />&ULPH <br />63.%33 <br />)LGHOLW\ <br /> <br /> <br />3URIHVVLRQDO/LDELOLW\63. <br />$JJUHJDWH <br />$EXVHDQG0ROHVWDWLRQ(DFK,QFLGHQW$JJUHJDWH <br />2UDQJH&RXQW\*RYHUQPHQW)LQDQFH $GPLQ6HUYLFHV <br />32%R[ <br />+LOOVERURXJK1& <br />DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606