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ACORDs
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />71'01A
<br />DATE :M W CO,YYYY!
<br />9.25 2015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO 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 0 the certificate holder is an ADDITIONAL INSURED. the policylles) must be endorsed. 0 SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />INSURED
<br />1 xkton CLmt^aiIles
<br />I 01 F i. mon \,. er•.tt.
<br />tiuit, 700
<br />1) nv'cr CO tiii237
<br />(.10;) 4 t4-1•1)(11)
<br />Labor Read\ \;!t:il e,:t. 4r.
<br />r lri;{-:)•) f11 I{i.\:'1!11
<br />101: •\ Sunt
<br />Tacoma. \t -\ ' i 40I
<br />1100$368"8
<br />CON'ACT
<br />RAKE
<br />�
<br />vNONC
<br />I..EMAI1...EJ3-
<br />Ewe,
<br />i ADDRESS. .-___ _
<br />l INSURERSI AFFORDING COVERAGE
<br />j INS.JRER A \ational L;nrun Fire tn: Cu Pitts P•\
<br />) INSURER a \e Hampshire Ins: r:ince ( urnpan\-.-_
<br />1INSURERC In)ur4110. COI:1Wank. 0 the State of I'r\
<br />' Pat
<br />LA'C, Vii=
<br />INSURER 0
<br />INSURER E
<br />1
<br />I INSURER F
<br />NAJC ■
<br />94.31
<br />13R4 I
<br />1 44 '9)
<br />•
<br />REVISION NUMBER:
<br />TrOS IS -o CEHTIFY TriAT TI IE PO_:CIF3 OF INSURANCE USI ED BE' 011 •IA:E DEEM !SSL'EO TO THE INSURED NAMED AL3O:'E FOH IHE PCLICY PEPIOC
<br />INDICATED. NOTW!TH3TAPtOING ANY REQUIREMENT rEHR1 O4 COr'O(Ti01k. OF ANY CONr7t\CT OR OTHER DOCUMENT WITH RESPECT TO WWII' rrItS
<br />Cc RTGIcArE MAY DE ISSUED OR MAY PER-.AIf, THE INSURANCE AFFORCEO Dv THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A_L THE TERMS
<br />ExC1.US')NS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HA': E SEEN REDUCED BY PAID CLA:MS
<br />I NSR - __TYPE Oa INSURANCE--ADoI fUBR -_— POUCY NUMBER tM WOO/YrYYI IMMi0O!YEYYI LIMITS
<br />LTR IN3C MI,
<br />COMMERCIAL GENERAL UABILRY . .T < Ici.Cn OCv11RRE`:1r S 1000,000
<br />T• :\ 5 \ I"_G.: 1 _Ulf, �._.
<br />DACE \ DCcV— p .AIS: T` Ra•:T'v_- 5 1.000.000
<br />X. PRE_JtScSlEaccc,=:ence;
<br />_.._. _LY•JS
<br />\ SIRSI\1 _=�EA',.tiry.•ieoe.3:n_ s XXX XNX> _.
<br />_ __. . _' --.'- -- ' H5OPAL 3 ADV INJt:RY 5 1 .000,000_
<br />- - -
<br />GENT AGGREGATE LtwT APDLIcs oE4 GENERAL AGGREGATE S 5.000.000
<br />^X or•:ICv 70" LOC P40 -'.....CTS - COMP'C? ACO S 3,000,001) -..,
<br />5
<br />Cs.THER.
<br />COBINc`J SINGLE L'MIT
<br />A AUTOMOetLEL!ABIUTY \ \ :11 09.. SI tAO' 1 CJI? i I•:(116 ,EaM.y;4rs±t1- 5 1.000,000
<br />;03(.1979 ' I :Uri " 121116
<br />\ F\ ANYALTO jlliltV7r(MA; -'I'_o1i T•I.:We _ BOOR V iWURY;No Della,"i_ 5_\( XXX > x
<br />• . AL: OWNED — SCHECuLEO 9('D'Lv l'UL'":P0> ecc:c.rn ; xxxxxxx
<br />1 Al. !OS AL rC5- - -
<br />-__ .— .RC'•EgryyALl:.:i_ S Y\\\\.XX
<br />NJ +-'., axc.eeri
<br />__. HIRu :,:705 AUTOS _. ._—. 5 xxxxxxx
<br />\ UMBRP_ a LIAR I x 0,..,:.,R N IN 19'1(1201S - I 2(''.5 '• 1 O. 1• E:,•=n Cr:/:LRREN_- s 5,90(1,000
<br />R
<br />EXCESS LAR. !
<br />_ ! CiAitr,.,J:.CE AGi.HFGATc _ ,___ 5 5.0(1(1,000--. DED T- . •:ETENT!C•;S 5 \XXXXXX
<br />WORKERS COMPENSATION -,E;t CT•. -
<br />n ANO EMPLOYERS' LIABILITY N. :1'1-S_59M 3I'A::9:4 •AOS - 1 1"1i '_ I :Jilr \ - AT.;Ti1 eP
<br />1 A..c Pc,Dp .' Y V '1J-I:911J.\IA. 21' 3')l.1•OR - 1 3.!j= I :(11n „ -_„_-VI 51.000.0011
<br />1L:F104:PL:TNiiZ£Ni.U: _ '--1 _ r t .•' _., •:_
<br />! TTN: a ) :1`N'•)rjl,..F! _ i '_ I 291i,
<br />tM.L: La. En•BER E[r_LUCE:1: \ - I `1-l_'� U: -L \.
<br />tManaatory in NH) L_ : ,S _A5- 1 -:7.11l(j'•cE a 1.001),0: )()
<br />II . :•:a•N r
<br />•- 2.c. -_1=O. o^rn:hoes e.,... ,:. eiena. - -- _•.n a 12)110,1)011
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<br />!1 Sor:rn 'Toa:pcO'..Un! 1 .:1.11! \ \ :1•0:3'313 - \:b :It )4:•ilc•\1`. - t :It : 1 ':iii, \'.L c.1..tttt,x-, EL 1 i:1,:'
<br />.\ F.'.:t. \\.Irk Comp yvs.,gL•(Ltli; 21)': 7 1 2:>16 )'. INN, U.:T:
<br />DESCRIPTION OF CPERATIONS LOCATIONS I VEHICLES .ACORO IDI AddiUcnat Romarna Scheouie may W aa.<he0 d more acne is rtouUoa;
<br />... t'.'. ac.� apoi, u:.::,) 4 I 1px.::: ..:ib.•r r4. : :..,:c!:. .c�-c or. bc11s::..t 1%,::.,; rt, -u4.' \L:a::aan. 1 ‘‘,2,.1, '., ir;, e \L ::•
<br />i.i.mploc :e. d;T
<br />_ :..1;:u:..
<br />.,t.:n.igl;l kner CdJi::. Ptir.:n.'.,irr :1t ...•n.,._ m:!:..!,:d .. A1, 4:rn s! Il:•..: -. tt, b• .. icr:., n1r.,:i'ca:.c_.^. 1.t. -r R..I s..:.a:._ i\, . 1'101.U.,
<br />. .:,•ri.:I:Ci..c int: ac resp.:.. Gcncni 1 1.4 '!!`1'
<br />CERTIFICATE HOLDER
<br />13685880
<br />India:: R:vcrCOLlnI) Purch.stne Division
<br />1100 27th Stre.t
<br />4eni Beach. FI i2960
<br />CANCELLATION
<br />SC.: A1tain111 nt
<br />ACORD 25 (2014101)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />aUT4+ORIZED REPREAT(VE
<br />CdeS
<br />tto1
<br />1988-7014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORO
<br />
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