WACKY CHAD - Laserfiche WebLink

Home

ACaR�0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 10/27/2016 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 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 HMK Insurance 54 South Commerce Way 150 Bethlehem PA 18017 CONTACT Kimberly Rice NAME: y PHONE No. Ext1n ( 610) 868 -8507 FAX No : (610) 868 -7604 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Atlantic Specialty Insurance 27154 INSURED International Brotherhood of Magicians and Chadd Deitz 94 Roosevelt Road Medford MA 02155 INSURER B: INSURER C: INSURER D: INSURER E: $ 1, 0 0 0, 0 0 0 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:AI - 2016 -2017 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 0 0 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ r A CLAIMS -MADE F_x]OCCUR LO1057 -07 08/15/2016 8/15/2017 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1 , 000 , 000 F-1 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1 , 000 , 000 X1 POLICY PRO- LOC JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION EMPLOYERS' LIABILITY Y/N WC STATU- I O TORY LIMITS ER ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? F—] NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured: City of Riverside, and its officers, employees and agents Effective Date: 10/26/2016 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) 1K]Qn')C ion,nntiN n, ©1988 -2010 ACORD CORPORATION. All rights reserved. -r". A / 'f Mr% NA.. ANA 1A AMA A.0 A / 'f Mr% SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Riverside 3900 Main Street AUTHORIZED REPRESENTATIVE Riverside, CA 92522 T Hartzell, CPCU , CIC 71w-mao 12 V. pC LI ACORD 25 (2010105) 1K]Qn')C ion,nntiN n, ©1988 -2010 ACORD CORPORATION. All rights reserved. -r". A / 'f Mr% NA.. ANA 1A AMA A.0 A / 'f Mr%