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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. ** SAMPLE CERTIFICATE **
<br />SALEENG-01
<br />
<br />MSELTZER .eitc_c_PfeL3
<br />‘Iseeee.-------CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
<br />12/02/2020
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # 0E02096 CONTACT
<br />DiBuduo & DeFendis Insurance Brokers, LLC
<br />P.O. Box 5479
<br />ALME:
<br />PHONE
<br />No, Ext): (559) 432-0222 FAX
<br />1 (A/C, No):(559) 431-7941
<br />Fresno, CA 93755-5479 ,-1313%ss:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A : Valley Forge Insurance Co 20508
<br />INSURED INSURER B:American Casualty Company of Reading PA 20427
<br />Salem Engineering Group, Inc. INSURER C: Continental Insurance Company 35289
<br />4729 W. Jacquelyn Ave.
<br />Fresno, CA 93722 INSURER D : National Fire Insurance of Hartford 20478
<br />INSURER E : Continental Casualty Company 20443
<br />INSURER F:
<br />COVERAGE ISL.,/ 5...1,J., 1•4,./11111,Let.
<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 />INSR
<br />LTR TYPE OF INSURANCE ADDL
<br />INSD
<br />SUBR
<br />WVD TP-OLICY EFF POLICY NUMBER IM M/DD/YYYY)
<br />POLICY EXP
<br />IMM/DEVYYYY) LIMITS
<br />A X COMMERCIAL GENERAL LIABIUTY
<br />X 6015893246 12/01/2020 12101/2021
<br />EACH OCCURRENCE x 2,000,000
<br />CLAIMS-MADE X OCCUR RplaaroNTEnDencei $ 300,000
<br />MED EXP (Any one person) S 15,000
<br />PERSONAL & ADV INJURY $ 2,000,000
<br />GEN'L AGGREGATE
<br />POLICY
<br />OTHER
<br />X
<br />LIMIT APPLIES
<br />IT
<br />PER,
<br />LOC
<br />GENERAL AGGREGATE $ 4,000,000
<br />PRODUCTS - COMP/OP AGG $ 4,000,000
<br />$
<br />B
<br />X
<br />_
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED
<br />AUTOS ONLY
<br />HIRED ONLY
<br />SCHEDULED
<br /> AUTOS
<br />NAV4-tsTNELI?
<br />6045473729 12/01/2020 12/01/2021
<br />COMBINED SINGLE LIMIT
<br />_as accident) $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per ac,cident) $
<br />PROPERTY DAMAGE (Per accident) 5
<br />$
<br />C X UMBRELLA LIAB
<br />EXCESS LIAB
<br />X OCCUR
<br />CLAIMS-MADE 6015893.:32 12/01/2020
<br />r
<br />12/01/2021
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE 5,000,000 _5
<br />DED X RETENTIONS 10,000 a
<br />D WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />parary417rAX EXCLUDED?
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />6020581635 12/01/2020 12/01/2021
<br />y PER 0TH-
<br />" STATUTE ER
<br />El. EACH ACCIDENT S 1,000,000
<br />El. DISEASE - EA EMPLOYEE $ 1,000,000
<br />Et DISEASE-POLICY LIMIT $ 1,000,000
<br />E
<br />E
<br />Prof./Pollution Liab
<br />Prof ./Pollution Liab
<br />AEH59185527
<br />AEH59185527
<br />12/01/2020
<br />12/01/2020
<br />12/01/2021
<br />12/01/2021
<br />Each Claim
<br />Aggregate
<br />2,000,000
<br />4,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />**Actual Certificate to be issued upon request**
<br />Certificate Holder is named Additional Insured (including Ongoing & Completed Operations and Primary Non-Contributory Wording) as respects General
<br />Liability per attached blanket policy form CNA75079XX (10-16).
<br />— Professional/Pollution Liability Deductible per claim - $25,000
<br />CERTIFICATE HOLDER CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
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