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PRODUCER <br />'' Sar~~rick Jam:: <br />~; .a^I 'n-!_nd. inc. <br />ro..a .t^~et <br />.. Boni .':T ., 1 . <br />iT. L~~U;_ ".0 :.1 ._ <br />a ISSUE DATE {MINDOI'M <br />R. <br />x.1/11/'1 <br />7N19 CERTIFICATE IS ISSUED A9 A MATTER OF INFORMATION ONLY AND CONFERS <br />NO RN:NYS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NpT AMEND, <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />COMPANIES AFFORDING COVERAGE <br />COLIPANY ~ .. '. i T ... . L i C 'i .. ~ : °' S . ~ ":. <br />LETTER <br />CCMPANV <br />LETTER 3 <br />COMPANY <br />LETTER <br />CCMPANV <br />LETTER <br />COMwANV ~, <br />LETTER <br />THIS H1 TO CERTIFY THAT POLICIES OF INSURANCE LISTED 9ElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP THE POLICY PERIOD INDICATED. <br />NOTNTTNSTANDINO ANY REOUIREMEHT. TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITN RESPECT TO 'MMICX THIS CEATIFICATE MAY <br />BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS, AND CONOH <br />TIONB OF SUCH POLICIES. <br />%? <br />' CO <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />''0(~' FIEECirvE <br />POtiCI (RRrui!CM j LIABILITY lI.M1TS IM TXOUSAND9 <br />LTR SATE IMIWODMI 111E IMMgDYYI cA '~ AODREOATE <br /> •r~~,;wwENGE <br />' ,1 <br />s GENERAL IUBILITY :; L ,; , '; . , .1 / L~ 1 / -'I <br />~ / -1 ~ <br />~ ~ / <br />o0cq. I <br />- COMPflEXENSR'E fORM r L _ 4 V ~~ ~ : - i 1'I J ~ \.baV { J <br />L S <br /> <br />PREMISES/OPERATIONS <br />!i L ~ n _ - / ~. ~ ~: ~ V %. i <br />I I <br />wwpPEAi"'; <br /> ~ I _AMALE '. S I T <br /> X EXPLO$IO <br />N 8 COI <br />LAP$E HAZARD J <br /> . ' <br />~,~ X PRODIICTS/COMPLETEO OPEMTIONS ~ <br />.{. ,~( CONTPAOTUAC~ I COUSmECjJ ^ V'„' $ 1:00 <br /> ~( INDEPENDENT CONTMCTORS <br /> V BROAD FORM PROPERTY DAMAGE I <br /> <br />PERSONAL INJURY <br />I <br />aEPSONAL IWURV ` <br />g I <br />~` Y <br />~ z2p07 P(l iiM rl -'-1~ ~$ ~1: '/=.''! 1~'7LL'U':' ~ ' ' <br />'.} ~ AUTOMOBILE LIABILITY 0:: <br />; . <br />~ ` <br />: 1 ! ~ 1 / 'i i I 1 : / : 1 / ~ 1 '-'~.' I .. ~ ",. <br /> _ . <br />. <br />_ <br />. ~~ ~ ~~'tti~`• <br /> ANYauro :;1;~?-~ ~'•:J 11';,,.., , ::~M g ~ : <br />' <br /> PR <br />A <br />TO <br />PA ~ - ~ ' I R Y'{ <br /> S ( <br />N. <br />AIL OWNED <br />U <br />SS 1 '/ i . il^,r . <br />~' :~ <br />~ <br /> <br />~' A ALL OWNED AUTOS OTHER THON I /~ eSR,'0 $ ~.': ~:,'•~•:~ <br /> PRIV. PA$$ <br />>' ~ <br />T~~ <br />~ Y MIRED AUTOS ePOVEPTV ' <br />, <br /> ;( NON-0WNEO AUTOS CAMAGE g' <br />~' <br /> GAPAGE LIABILRY ~ w - ~t~' <br />~~';' <br /> 91 a <br />0 <br />COM81NE0 $ 1 :Qf . <br />^ti~.~_(.1 <br /> E%CE39 UABILRY ~ ~ " <br /> ~ ( <br />1 ''s <br /> UMBRELLA FORM ~ .: ~ I ~ . BI A v0 S ' <br /> I COMBINED $ ~ <br />. <br /> OTHER THAR UMBPEIU FORM ~ ~ ~ I <br />'/ <br />: WORI(ERB' COMPENSATION <br />~ ~ _ ! STATUTORY - <br /> <br />%? . <br />AND _ ~ $ (EACH ALCICEHTI <br />. <br />. <br />EMPLOYERS' LIABILITY C,A IGISEASEi'p;ICY LIMIT) <br />~ <br />'~ ' ~ ~ ~ S I(1ISEASFEACH EMPLOYEEI:• <br /> OTHER I ~ ' <br />1 <br />DESCRIPTION OF OPERATIONS/LOCATIONSI'ENICLE S/SPECIAL ITEMS ~ ~ '/ .. .: L ~ ~' 1 _ T i~ I. ,: L ~ /. ' ~: J / .'. C L :' .. , ', <br />_ -'q7 ... iI-W ~4I;~_ a'JD I.`!l. L~~_ ... ~i '.,2i ~: I _'.. _ .'.L °:.; ~. <br />-2?ki.TT_0'i .iA Tr.c U.i_ q. -.,.'L; ~.~'•/. .A' .?!1 ,. .•.. - 'A_I_~?.. , <br />:1r ~::VT_N~,~r:L ~LC~. <br />1::1; ~~-~r~nv ;r~=_~~ <br />DFSIVER 00 80230 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- <br />PIRATION DATE THEREOF, THE IS$l•;{IjCh OQl///~AI~ IN~-i„J;E/y EAVOR TO <br />~ ~ MAIL GAYS WRITTEN NOTICE AAT~OT ~T+1 MVOA.T QHgOLI~JYJ~I'JQAYMED TO THE <br />n ANeUNINONUPONO EACOMPAN`/O IY a'A I~/AC-1 IO~EP SE'Nl`ATIJI~~V <br />AUTHORIZED REPRESENTATIVE <br />BY ..'~ l~„ <br /> <br />