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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />PRODUCER CONTACTNAME:
<br />PHONE(
<br />A/C, No, Ext):
<br />FAX
<br />A/C, No):
<br />E-MAILADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A :
<br />INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:XXXXXXX
<br />INSRLTR TYPE OF INSURANCE ADDLINSD SUBRWVD POLICY NUMBER
<br />POLICY EFF(
<br />MM/DD/YYYY)
<br />POLICY EXP(
<br />MM/DD/YYYY)LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-
<br />JECT LOC
<br />OTHER:
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)
<br />PERSONAL & ADV INJURY
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMP/OP AGG
<br />COMBINED SINGLE LIMIT(
<br />Ea accident)
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE(
<br />Per accident)
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED
<br />AUTOSONLYHIRED
<br />AUTOS ONLY
<br />SCHEDULED
<br />AUTOSNON-OWNED
<br />AUTOS ONLY
<br />UMBRELLA LIAB OCCUR
<br />EXCESS LIAB CLAIMS-MADE
<br />DED RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Y / N
<br />N / A
<br />PERSTATUTE OTH-
<br />ER
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<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 />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />1988-2015 ACORD CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />Lockton Insurance Brokers, LLC
<br />777 S. Figueroa Street, 52nd Fl.
<br />CA License #0F15767
<br />Los Angeles CA 90017
<br />213) 689-0065
<br />MCCi, LLC
<br />3717 Apalachee Parkway
<br />Tallahassee FL 32311
<br />MCCIL01
<br />12/1/2023 11/29/2022
<br />1456427
<br />X
<br />X
<br />X Comp. Ded. $100
<br />1,000,000
<br />XXXXXXX
<br />XXXXXXX
<br />XXXXXXX
<br />Coll. Ded.1,000
<br />X X
<br />X 10,000
<br />5,000,000
<br />5,000,000
<br />X
<br />X
<br />X
<br />1,000,000
<br />1,000,000
<br />15,000
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />Tech E&O/Cyber Liability Limit: $5,000,000
<br />SIR: $50,000
<br />N
<br />X
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />American Casualty Company of Reading, PA 20427
<br />The Continental Insurance Company 35289
<br />Travelers Property Casualty Co of America 25674
<br />Valley Forge Insurance Company 20508
<br />B 6072067343 12/01/2022 12/01/2023
<br />A 6072067360 12/01/2022 12/01/2023
<br />D ZPL-5IN599A-22-I5 12/01/2022 12/01/2023
<br />C 6072067357 12/01/2022 12/01/2023
<br />C 6072067326 (AOS)12/01/2022 12/01/2023C6079501170 (CA)12/01/2022 12/01/2023
<br />See Attachment
<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 BELOW.
<br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE
<br />OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
<br />ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />DocuSign Envelope ID: 4A979C4C-7C9F-48F2-8F22-D293B7FEAA7B
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