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1' 1 <br /> This certificate is issued as a matter of information. This certificate isnot an insurance <br /> policy and does not amend, extend or alter the coverage afforded by the policies listed <br /> herein. Not withstanding any requirement, term or condition of any contract or other <br /> document with respect to which this certificate of insurance may be issued or may <br /> pertain, the insurance afforded by the policies described herein is subject to a11 the <br /> terms, exclusions and conditions of such policies. <br /> Agency or Brokerage <br /> Insurance Company { <br /> Address Home Office <br /> Name of Person to be Contacted Authorized Signature <br /> Telephone Number Date <br /> NOTE:Authorized signature may be the agent's if agent <br /> has placed insurance through an agency <br /> agreement with the insurer. If insurance is <br /> brokered, authorized signature must be that of an <br /> official of insurer. <br /> t <br />{ <br /> DIVISION IV -32 <br /> a <br />