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GENERAL44944
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GENERAL44944
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Entry Properties
Last modified
8/24/2016 8:13:38 PM
Creation date
11/23/2007 1:26:50 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
1/21/2000
Doc Name
CERTIFICATE OF LIABILITY INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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'ACORD,.::CER.TIF:iG:A~':':0~. ::LIB LITY .:IN . RANGE ' <br />III IIIIIIIII IIII III <br />PROpucER .......... ... ...... .. ......... THIS CERTIFICATE IS ISSUED AS A I ggg <br /> ONLY AND CONFERS NO RIGHTS t/rlrn Int CGNIIHIUAIE <br />MARYLAND HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Y[GRIFF, SEIBELS AND WI LLIAYS ALTEfl THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />10320 LITTLE PATUXENT STE 700 COMPANIES AFFORDING COVERAGE <br />COLUMBIA YO 21011 COMPANv <br />(110) 881-5800 /+ OLO REPUBLIC INSURANCE [0 <br />INSURED RECEIVED COMPANY <br />Oxbem Yi nlnp, Ine. B <br />1601 Ferum Pltc• COMPANY <br />West Pelm, FL 33101 JAN 2 i 2ppp c <br /> COMPANY <br />Division of D <br /> <br />THIS IS TO CERTIFY THATTHEPOLICIES OFINSURANCE LISTED BELOW HAVE BEENISSUED TO THEINSURED NAMED ABOVEFOR 7HEPOLICY PERIOD <br />INDICATED,NOT WITHSTANDINGANVREOUIREMENT,TERMOR CONDITIONOFANYCONTRACTOROTHERDOCUMENT W ITHRESPECTTO WHICHTHIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURAN CE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY F%PIRATION LIMITS <br />LTR GATE (MMIOOIYYI DATE (MMIDDIYY) <br /> GEN ERAL LIABdITY GENERAL AGGREGATE f <br /> COMMERCIAL GENERAL LIABILRY PRODUCTS~COMP/OP AGG f <br /> CLAIMS MADE ~ OCCUR PERSONAL A ADV INJURY f <br /> OWNER'S 6 CONTRACTOR'S PROs EACH OCCURRENCE f <br /> FIRE DAMAGE (Any one lire) f <br /> MED E%P (Any one person) f <br /> AUT OMOBILE LIABRITY <br /> COMBINED SINGLE LIMIT f <br /> ANY AU70 <br /> ALL OWNED AUTOS BODILY INJURY <br /> <br />(Per person) f <br /> SCHEDULED AUTOS <br /> HIRED AUTOS BODILY INJURY <br />f <br /> NON~OWNED AUTOS (Per acc itlenU <br /> PROPERTY DAMAGE f <br /> <br /> GARAGE LUBRITY AUTO ONLY . EA ACCIDENT f <br /> ANY AU10 OTHER THAN AUTO ONLY: <br /> EACH ACCIDEN7 f <br /> AGGREGATE f <br /> E%CESt LIABdrtY EACH OCCURRENCE f <br /> UMBRELLA FORM AGGREGATE f <br /> OTHER THAN UMBRELLA FORM f <br />A WORKER6 COMPENSATION AND OBC01707302 1/01/00 1/01/O1 X C S A - O H~ <br />R Mli R <br /> EMPLOYERB'LIABILITY EL EACH ACCIDENT S 1,000,000 <br /> iME PROPRIETOR/ <br />PARTNERS/EXECUTIVE INCL EL DISEASE~POLICY LIMIT f 1,000,000 <br /> OFFICERS ARE: EXCL EL DISEASEEA EMPLOYEE f 1,000,000 <br /> OTNER <br />DESCRIPTION OF OPERATIONBA.OCATIONpIVEHICLEBIePECIAL ITFMB Re; Workers' Compensetlon <br />OYG Permit No. 0-81-022 Csrtif ieete of Insurene• rep/ eeec end vaidc previ oucly itcuad <br />certif leetes. <br />~GER.TiFICA:TE.HOLD.ER::.::..:'::::::'::.::'.':'.:~ ::..:.:..:.:.: .::..:..:~,.:~,.:~,:.:.,:..:. .:~~~::~~..'.:~':'::' :CANCE.LLATION:..::..::.::..::':: ~:: ~'~'.::': ~::~~:~:~: ~.:~~:":::. ~:~:.: ~::::: ~::~'.: ~: ~::': ~.::.: ~.: ~; ~:.::: ~.::.::.:. <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Divi ti en of Yinerelt 6 EXPIRATION DATE THEREOF, THE 188UING COMPANY WILL EXItlBRW011000nk1AIL <br />Gee I epy 30 DAYS WRRTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, <br />Attn: Oeve Berry YNMlOKY1W1fIBI111NUY0Q"IYYXFNYYXIkmfYXY7NDUDYIXY%TNfMXRYCMOBIYNXX% <br />1313 Sherman Street MWIXXIRWIWX XXRAXIf70F>OWXOnIAl1X)R9RRBBRNDRO1IflIWC <br />Reom 215 A ORIZED RE A <br />Oenrer, CO 90203 <br />................: r'.:.::...:.....:......:.:.....:.:...:..:.:............ <br />~:AGO.RD:2$:g:.11~95~~'::~~:.r;.r:::rii::i:'.:::~.':.:.:.:~.::;:~:.::.:.:.'.:'.:~:'::~':'::: <br />'~::~::.::::~.:~.:: <br />.:~.:~.:~.'.:.'~:'.'.:'..'.:'.:~..:.::;.:::: ~::~~:: ~::~~::~:': ~.:.: .: :':~ .~AC.ORD:GOgPOHATI.ON: 1:989.; <br />CERTIFICATE: 003/003/ 00017 <br />
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