WP0041563 - Laserfiche WebLink

Home Browse Search

TWINLAB-01 SMOLLECK ACORN' CERTIFICATE OF LIABILITY INSURANCE DATE 08/03/2020 Y) 08/03/2020 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 have ADDITIONAL INSURED provisions or 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 License#OE02096 CONTACT Sandra Molleck NAME: DiBuduo&DeFendis Insurance Brokers,LLC PHONE FAX P.O.Box 5479 (A/C,No,Ext): (A/C,No): Fresno,CA 93755-5479 AUDRIL ,sandra.molleck@dibu.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Nationwide Mutual Insurance Company 23787 INSURED INSURER B:State Compensation Insurance Fund 35076 Moore Twining Associates,Inc. INSURER C P.O.BOX 1472 INSURER D: Fresno,CA 93716 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD YV V MMD YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F—]OCCUR DAMAGE TO RENTED PREMI E E n n $ MED EXP(Any one rson $ PERSONAL&ADV INJURY $ GEN'IL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG JE CT OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X .ANY AUTO ACP3047734643 06/14/2020 06/14/2021 BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY lPer accident $ X HIRED ONLY X AUOTOS ONLD (ROPERTY DAMAGE er accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ $ B WORKERS COMPENSATION X PER OTH- ANDEMPLOYERS'LIABILITY 923042220 05/01/2020 05/01/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑YN N/A E.L.EACH ACCIDENT OFFICER/M%W EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE 1'000'000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) When required by written contract the certificate holder, is listed as Additional Insured with a Waiver of Subrogation and Primary Non Contributory Clause on the Commercial Automobile per attached AC 70 05 03 16. Waiver of Subrogation applies on the Workers Compensation per attached SCIF Form 10217 (REV.7-2014) Insured:30 day Notice of Cancellation/10 day Non Payment See SCIF FORM 10271(Rev.7-2014) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD