|
SALEENG-01
<br /> ACORo CERTIFICATE OF LIABILITY INSURANCE DATE IMMDDYYY
<br /> 11/29/2016
<br /> CONTRACTORS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> dG� STATE LICENSE BOARD - CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> ACTIVE LICENSE 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 /> .-. 970772 CORP IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> SALEM ENGINEERING GROUP INC If SUBROGATION IS WAIVED,subject to the temisand conditions ofthe policy,certain policies may requirean endorsement.Astatementon
<br /> DBA SALEM WELL DRILLING this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRooucER License#OED2096 RAkCT
<br /> DiBuduo 8 DeFendis Insurance Brokers,LLC PHONE PAz
<br /> P.O.Box 5479 A1C No EM:559 432-0222 A1C No 559 431-7941
<br /> -�•m^C57 ® Fresno,CA 93755-5479
<br /> D1411RE S AFFORDNO COVMV GE NAIL a
<br /> 03/31/2020 v—cslb ca.gov INSURERA:V811@ Fo aInsurance Co 20508
<br /> INSURED INSURER 8:Continental Casualty Company 20443
<br /> Salem Engineering Group,Inc. INSURER C:Continental Insurance Company 35289
<br /> 4729 W.Jacquelyn Ave. INSURERD:American Casual Company of Readin PA 20427
<br /> Fresno,CA 93722
<br /> ISURER E:
<br /> SURER F::
<br /> COVERAGESNUMB O NUMBER:
<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 /> BIBR TYPEOFINSURANCE
<br /> ADDLIOU POLICY NUMBER POLICY EFF POLICY E%P UNSTS
<br /> A X COMMERCML GENERAL LIABWTY EACH OCCURRENCE 2,000,000
<br /> DLAIMsauce�X OCCUR X 6015893246 12101/2018 1210112019 DAMADE TO RENTED 300,000
<br /> MEDEXP 15,000
<br /> PERSOHLLAAONINJMiT 5 2,000,000
<br /> DENL AGOREDATE UMITAPPl1E5 PER:
<br /> GENERAL A GATE 4,000,000
<br /> Poucr❑X Loc PRODUCTS-COMPUOPADD 4,000,000
<br /> OTHER! s
<br /> B AUroMOBILE LMBILItt ,CS
<br /> ,MBINEDSINGLE LIMIT 1,000,000
<br /> X ANY ALDO 045473729 1210112018 1210112019 SOOILYINUuRY r
<br /> OWTED SCHEDULED
<br /> AUTOS ONLY AAUUTTOS,Sµ}�Ep pBgOpDLYIFLURY arec ,,
<br /> AUTOS ONLY AMM O50N.Y PFr E
<br /> CX UMBRELLA We X occLR EACH OCCURRENCE 5,D00,000
<br /> EXCEss LIAR 6016893232 12/0112016 12101/2019 AGGREGATE 5,009,000
<br /> DED I X RETENRONS 10.000
<br /> D WORKERS COMPENSATION ]( PEN (illi
<br /> AND EMPLOYERS'UABILITY
<br /> ANYPROPRIE-ARTNERIEXECUTYE YI 20581635 12/01/2018 12/0112018 1,000,D00
<br /> pp�FFlCCERMEM99EERR EXCLUDED? NIA E.L.EACH ACGOENi S
<br /> IraantlalPry in NHI E.L.DISEASE-EA EMPLOYE 1,000,000
<br /> I/ s>urlm a,ael 1,000,000
<br /> DE SC RIPTIONOFOPERATIONS a. E.L.DISEASE-POLICYLIMIT
<br /> B Prof./Pollution Liah AEH591895527 1210112018 12/01/2019 Each Claim 2,000,000
<br /> B ProfJPollution Liab EH591896527 1210112018 1201/2019 Aggregate 4,000,000
<br /> DESCRIPTION OF OPEMTIONS/LOCATN)NS I VEHIOlEB IACORD 101.AaEXb1MI RemerXa Scneauk,Rey Le eMceeE K mwe apace IF reaulne)
<br /> Actual Certificate to be Issued upon request"
<br /> Certificate Holder is named Additional Insured(including Completed Operations and Primary Noncontributory Wording)as respects General Liability per
<br /> attached blanket policy form CNA75079XX(10-16).
<br /> "Professional/Pollution Liability deductible per claim-$25,000
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> "SAMPLE CERTIFICATE" THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHOR-REPRESENTATNE
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|