|
`_.-MINAk SALEENG-01 MSELTZER
<br />ACORO"
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)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 # OE02096
<br />DiBuduo & DeFendis Insurance Brokers, LLC
<br />P.O. Box 5479
<br />Fresno, CA 93755-5479
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />(A/C, No, Ext): (559) 432-0222 (A/c, No):(559) 431-7941
<br />EDDA E ;
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />12/01/202
<br />INSURER A: Valley Forge Insurance Co 20508
<br />EACH OCCURRENCE 2,000,000
<br />INSURED
<br />INSURER B: American Casualty Company of Readin_q PA 20427
<br />INSURER C: Continental Insurance Company 35289
<br />Salem Engineering Group, Inc.
<br />INSURER D: National Fire Insurance of Hartford 20478
<br />4729 W. Jacquelyn Ave.
<br />Fresno, CA 93722
<br />INSURER E: Continental Casualty Company 20443
<br />INSURER F
<br />AUTOMOBILE
<br />X
<br />COVERAGES CERTIFICATE NUMBER: REVISION 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />D YY
<br />POLICY EXP
<br />M DD YY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX-] OCCUR
<br />X
<br />6015893246
<br />12/01/202
<br />2/01/2021
<br />EACH OCCURRENCE 2,000,000
<br />DAMAGE TO RENTED occurrence) $ 300,000
<br />PREMISES fEaMED
<br />EXP (Any oneperson) $ 15,000
<br />PERSONAL & ADV INJURY 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ] JECOT- F-1LOC
<br />OTHER:
<br />GENERAL AGGREGATE $ 4,000'000
<br />PRODUCTS - COMP/OP AGG 4,000'000
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUT�O�S ONLY AUTOp
<br />AUTOS ONLY AUOTOS ONLY
<br />6045473729
<br />12/01/2020
<br />12/01/2021
<br />COMBINED SINGLE LIMIT 1,000,000
<br />$
<br />BODILY INJURY Perperson)
<br />BOODILY INJURY Per accident $
<br />PPe�acatlentDAMAGE $
<br />C
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />6015
<br />12/01/2020
<br />12/01/2021
<br />EACH OCCURRENCE $ 5,000,000
<br />AGGREGATE $ 5,000,000
<br />DED X RETENTION $ 10,000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />PROPRIETOR/PARTNER/EXECUTIVEAAFFICEER EXCLUDEDY❑
<br />(Mandatory in BE )
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA A
<br />6020581635
<br />12/01/2020
<br />12/01/2021
<br />X PER OTH-
<br />1,000,000
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYE $ 1'000,000
<br />E.L. 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 2,000,000
<br />Aggregate 4,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />'* SAMPLE CERTIFICATE **
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<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
<br />
|