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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 OWNED SCHEDULED
<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 />COVERAGES CERTIFICATE 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 />3/19/2018
<br />Integra Insurance Services,Inc.
<br />14107 Winchester Blvd.,Suite V
<br />Los Gatos CA 95032
<br />Joan Fabricius-Lyons
<br />408-335-1203 408-354-3454
<br />jlyons@integra-insurance.com
<br />Federal Insurance Company 20281
<br />WRIKE-1 Indian Harbor Insurance CoWrike,Inc.
<br />70 N 2nd Street
<br />San Jose CA 95113
<br />Lloyd's of London
<br />Chubb Insurance Group 41386
<br />1068373103
<br />A X 1,000,000
<br />X 1,000,000
<br />10,000
<br />2,000,000
<br />2,000,000
<br />X
<br />36032286 9/17/2017 9/17/2018
<br />4,000,000
<br />A 1,000,000
<br />XX
<br />73590764 9/17/2017 9/17/2018
<br />A X X 5,000,00079897208
<br />5,000,000
<br />9/17/2017 9/17/2018
<br />D 71756094 10/4/2017 10/4/2018 X
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />B
<br />C
<br />A
<br />Prof E&O/Cyber
<br />Excess E&O/Cyber
<br />D&O Liability
<br />MTP903280702
<br />ESG02402174
<br />82476008
<br />10/26/2017
<br />10/26/2017
<br />5/4/2017
<br />10/26/2018
<br />10/26/2018
<br />9/17/2018
<br />Limit:5,000,000
<br />Limit:5,000,000
<br />Limit:5,000,000
<br />Ded:25,000
<br />Ded:10,000
<br />Proof of Insurance
<br />Proof of Insurance
<br />DocuSign Envelope ID: F16357C3-9192-420F-BE7E-DF351004EFCD
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