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['IHR 7-1995 03:59 P.U411�4
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<br /> COMPANY:Association Insurance Management THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br /> NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT
<br /> PHONE:900-876-4044 AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHF POLICIES BELOW,
<br /> INSURED: INSURANCE COMPANIES PROVIDING COVERAGE
<br /> Unooln Music Boosters INSURANCE COMPANY A: American Safety indemnity
<br /> 9844 Alexandria Place
<br /> INSURANCE COMPANY B
<br /> Stockbon,CA 95207
<br /> INSURANCE COMPANY C
<br /> �.;;'r„r'-"'M ' �. ;�`�:Ytd .fid ..aT!`�'� x1.y4a74%' f «k. r I ,.I �� _ -�-,;'9,,- r• - iC° •�.. �, r. Thr -c-:�4 P..1.,is r,;:F �':fgi '4.,`,.
<br /> CO, TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY EXP. ALL LIMITS IN
<br /> LTR DATE DATE THOUSANDS
<br /> GENERAL LIABILITY GENERAL AGGREGATE PER PROJECT
<br /> Cx)COMMERCIAL GEN LIABILITY
<br /> ( ]CLAIMS MADE PRODS-COMPIOPS AGG 2,000,000
<br /> [ ]
<br /> OCC.
<br /> ( ]OWNERS& PERS&ADVG INJURY 1,000,000
<br /> CONTRACTORS
<br /> PROTECTIVE
<br /> ( ]OCCURRENCE EACH OCCURRENCE 11000,000
<br /> [ 1
<br /> FIRE DAMAGE 50,000
<br /> (ANY ONE FIRE)
<br /> MEDICAL EXPENSE 6,000
<br /> (ANY ONE PERSON)
<br /> AUTO LIABILITY CSL
<br /> [ ]ANY AUTO
<br /> [ ]ALL OWNED AUTOS BODILY INJURY
<br /> [ )SCHEDULED AUTOS (PER PERSON)
<br /> i 1 HIRED AUTOS
<br /> [ I NON OWNED AUTOS
<br /> ( 1 GARAGE LIABILITY BODILY INJURY
<br /> (PER ACCIDENT)
<br /> PROPERTY
<br /> EXCESS LIABILITY EACH OCC AGGREGATE
<br /> [ I UMBRELLA FORM
<br /> [ I OTHER THAN UMBRELLA
<br /> FORM
<br /> WORKERS COMPENSATION STATUTORY
<br /> AND EMPLOYERS LIABILITY EACH ACC
<br /> DISEASE POLICY LIMIT
<br /> DISEASE EACH EMPLOYEE
<br /> SPECIAL PROVISIONS:
<br /> 1)THIS INSURANCE SHALL BE PRIMARY INSURANCE IN RESPECTS TO(COMPANY NAME HERE),ITS OFFICERS,AGENTS AND EMPLOYEES,
<br /> 2)THE PROVISIONS UNDER PARAGRAPH 1 OF THIS SECTION.•SEPCIAL PROVISIONS,"SHALL APPLY TO CLAIMS,COSTS,INJURIES,OR DAMAGES BUT ONLY IN
<br /> PROPORTION TO AND TO THE EXTENT SUCH CLAIMS,COSTS,INJURIES,OR DAMAGES ARE CAUSED BY OR RESULT FROM THE NEGLIGENT ACTS OR
<br /> OMMIS$ION$OF THE NAMED INSURED,
<br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLE$/$PECIAL ITEMS
<br /> COMPANY NAME HERE PROJECT NAME:
<br /> COMPANY NAME PROJECT NO:
<br /> aro(Is)PRIMARY ADDITIONAL INSURED.
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<br /> AUTHORIZED REPRESENTATIVE:The undersigned certlTles that he/she Is authorized
<br /> to sign this certificate and that the special provisions described herein have been made a
<br /> part of the po[Icy(les)shown above.
<br /> ,0.
<br /> TOTAL P.04
<br />
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