CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)
3/19/13
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), AUTHORIED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT! I" #$% &%'#("(&)#% $*+,%' (- ). ADDITIONAL INSURED, #$% /*+(&0((%-) 12-# 3% %.,*'-%,. I" SUBROGATION IS WAIVED, -234%&# #*
#$% #%'1- )., &*.,(#(*.- *" #$% /*+(&0, &%'#)(. /*+(&(%- 1)0 '%52('% ). %.,*'-%1%.#. A -#)#%1%.# *. #$(- &%'#("(&)#% ,*%- .*# &*."%' '(6$#- #* #$%
&%'#("(&)#% $*+,%' (. +(%2 *" -2&$ %.,*'-%1%.#(-).
PRODUCER
B*+# I.-2').&% A6%.&0
17 8)#%'-(,% ,' 9:7:
F)'1(.6#*., CT
R*2., C(#0 ; C*.
::< 8%-# :9#$ -#'%%#
N%8 Y*'=, NY 17771
CERTIFICATE NUMBER!
CONTACT
NAME!
PHONE
(A/C, N*, E>#)!
E?MAIL
ADDRESS!
@)(1% G*+0
FAX
91A?9AB?9C71(A/C, N*)!
'*2.,&(#01*D(.6E1%.&*1
INSURER(S) AFFORDING COVERAGE NAIC 9
INSURER A !
INSURED
INSURER B !
INSURER C !
INSURER D !
INSURER E !
INSURER F !
COVERAGES 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 REFUIREMENT, 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 SUB@ECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
GENERAL LIABILITY
ADDL SUBR
INSR WVD
A
>
GLVB79:B777<
POLICY NUMBER
POLICY EFFPOLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS?MADE
>
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (E) *&&2''%.&%)
G
G
G
G
G
G
G
OCCUR
3/19/13 3/19/1<
MED EXP (A.0 *.% /%'-*.)
PERSONAL ; ADV IN@URY
GENERAL AGGREGATE
A >
GENHL AGGREGATE LIMIT APPLIES PER!
PRO?
POLICYLOC@ECT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
PRODUCTS ? COMP/OP AGG
COMBINED SINGLE LIMIT
(E) )&&(,%.#)
BODILY IN@URY (P%' /%'-*.)
1, 777, 777
177, 777
G17, 777
:, 777, 777
:, 777, 777
1, 777, 777
177, 777
B7, 777
B7, 777
TRVB79:B777<
3/19/13
SCHEDULED
AUTOS
NON?OWNED
AUTOS
3/19/1<
G
G
BODILY IN@URY (P%' )&&(,%.#) G
PROPERTY DAMAGE
(P%' )&&(,%.#)
G
G
> UMBRELLA LIAB
EXCESS LIAB
>
>
OCCUR
CLAIMS?MADE
CGVB79:B777<
EACH OCCURRENCE G
G
G
OTH?
ER
G
3/19/13 3/19/1< AGGREGATE
WC STATU?
TORY LIMITS
E.L. EACH ACCIDENT
17, 777
17, 777
B77, 777
B77, 777
B77, 777
GB77, 777
GB77, 777
DEDRETENTION G
WORIERS COMPENSATION
AND EMPLOYERSH LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/AOFFICER/MEMBER EXCLUDEDJ
(M).,)#*'0 (. NH)
I" 0%-, ,%-&'(3% 2.,%'
DESCRIPTION OF OPERATIONS 3%+*8
3/19/13 3/19/1<
E.L. DISEASE ? EAEMPLOYEE G
E.L. DISEASE ? POLICY LIMIT
A
A
CGVB79:B7173
3/19/13 3/19/1<
&)'6*
G
8)'%$*2-%
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (A##)&$ ACORD 171, A,,(#(*.)+ R%1)'=- S&$%,2+%, (" 1*'% -/)&% (- '%52('%,)
@*3 +*&)#(*.! :9 W BA#$ S#'%%#, NY, NY 17719
H).,01). 8*'=! /)(.#(.6, $).6(.6 -$%+D%-, )., "(>(.6 ,**' =.*3-.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIED REPRESENTATIVE
V*'.),* R%)+#0 T'2-#, :17 R*2#% < E)-#
P)')12-, N@ 7AKB:
ACORD :B (:717/7B)
L 19CC?:717 ACORD CORPORATION. A++ '(6$#- '%-%'D%,.
T$% ACORD .)1% )., +*6* )'% '%6(-#%'%, 1)'=- *" ACORD