DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 8/09/2021

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), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
KLIENT INSURANCE BROKERAGE PHONE 718-865-2160 FAX 973-368-2354
(A/C, No, Ext): (A/C, No):
1045 54th Street E-MAIL Hershy@klientinsurance.com
ADDRESS:
BROOKLYN NY 11219
INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : State Farm Fire And Casualty C

INSURED INSURER B :
PROGRESSIVE INSURANCE CO
BEST SUPER CLEANING LLC NYSIF
INSURER C :
5014 16th Ave Suite 231 State Farm Fire And Casualty C
INSURER D :
BROOKLYN NY 11204 INSURER E :

INSURER F :
COVERAGES CERTIFICATE NUMBER: 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 REQUIREMENT, 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 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X 92CTE7290 8/04/2021 8/04/2022
A X X DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 50,000
MED EXP (Any one person) $ 5,000
X Contractual Lia PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PRO-
JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
03336814-0 COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY 3/04/2021 3/04/2022 (Ea accident) $ 2,000,000
ANY AUTO BODILY INJURY (Per person) $
X
B OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$

X UMBRELLA LIAB X OCCUR 92CTE7302 EACH OCCURRENCE $ 2,000,000

X X 8/04/2021 8/04/2022
D EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
K2493 078-6 X STATUTE ER
AND EMPLOYERS' LIABILITY Y/N 4/05/2021 4/05/2022
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
E.L. EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

The Certificate Holder and the below are included as additional Insureds on a primary non Contributory Basis for ongoing and completed operations
as requierd by written contract agreement, per policy term and conditions. GL policy includes Waiver of Subrogation and
GL policy does not include any action over/ labor law /employers liability exclusion. Employers Liability Coverage
Job Location: 304 East 134th St., Bronx, NY 10454 (this was stated on our sample insurance set up)

CERTIFICATE HOLDER CANCELLATION

Rock Builders Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
670 Myrtle Avenue, #379 ACCORDANCE WITH THE POLICY PROVISIONS.
Brooklyn NY 11205
AUTHORIZED REPRESENTATIVE

Hershy Klein
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD