CERTIFICATE OF LIABILITY INSURANCE
|
|
- Ashlie Parsons
- 5 years ago
- Views:
Transcription
1 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC A AUTOMOBILE LIABILITY Y Y CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/30/2017 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, ETEND 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 Insurance Agency Name & Address INSURED Subcontractor Name Subcontractor Address City, MA 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, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY Y Y /1/2017 1/1/2018 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 CLAIMS-MADE OCCUR MED EP (Any one person) 5,000 CU PERSONAL & ADV INJURY 1,000,000 Contractual GENERAL AGGREGATE 2,000,000 B ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB ECESS LIAB SCHEDULED AUTOS NON-OWNED AUTOS OCCUR CLAIMS-MADE Y Y CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : PRODUCTS - COMP/OP AGG 2,000,000 COMBINED SINGLE LIMIT /1/2017 1/1/2018 (Ea accident) 1,000,000 EACH OCCURRENCE 5,000,000 AGGREGATE 5,000,000 DED RETENTION A WORKERS COMPENSATION WC STATU- OTH- Y ZWC /1/2017 1/1/2018 AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EECUTIVE E.L. EACH ACCIDENT 500,000 OFFICER/MEMBER ECLUDED? N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 500,000 C Professional Liability& Pollution Liability HIJKLM000 1/1/2017 1/1/2018 Per Claim 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Name, Project Location City, State. Jane Smith FA (A/C, No): jsmith@agency.com INSURER(S) AFFORDING COVERAGE A Insurance Company B Insurance Company C Insurance Company ABCDEFG 1/1/2017 1/1/2018 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) Dellbrook Construction LLC, the Owner, and all other parties as required by the written contract with Dellbrook Construction, are included as Additional Insureds on a primary and noncontributory basis where required by written contract, with respect to the Automobile, General Liability and Umbrella/Excess Liability policies. A Waiver of Subrogation applies in favor of the additional insureds where required by written contract with respect to the Workers Compensation, Automobile, General Liability and Umbrella/Excess Liability policies. Additional Insured See Attached... NAIC # CERTIFICATE HOLDER CANCELLATION Dellbrook Construction LLC One Adams Place 859 Willard Street Quincy MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
2 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Insurance Agency POLICY NUMBER NAMED INSURED Subcontractor Name Subcontractor Address City, MA CARRIER ADDITIONAL REMARKS NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE endorsements are issued on the ISO Endorsement CG /85 OR CG /01 AND CG / days notice of cancellation or material modification will be provided to Dellbrook Construction LLC. No residential exclusion applies. ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
3 EVIDENCE OF PROPERTY INSURANCE THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ETEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY Insurance Agency Name & Address City, State Zip PHONE (A/C, No, Ext): COMPANY A Insurance Company DATE (MM/DD/YYYY) 3/30/2016 FA (A/C, No): CODE: AGENCY CUSTOMER ID #: INSURED REMARKS (Including Special Conditions) ADDITIONAL INTEREST NAME AND ADDRESS ADDRESS: jsmith@agency.com Subcontractor Name Subcontractor Address City, MA PROPERTY INFORMATION LOCATION/DESCRIPTION COVERAGE INFORMATION SUB CODE: COVERAGE / PERILS / FORMS LOAN NUMBER THIS REPLACES PRIOR EVIDENCE DATED: LOAN # EFFECTIVE DATE 1/1/2016 1/1/2017 MORTGAGEE LOSS PAYEE AUTHORIZED REPRESENTATIVE EPIRATION DATE ADDITIONAL INSURED POLICY NUMBER IM AMOUNT OF INSURANCE CONTINUED UNTIL TERMINATED IF CHECKED 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 EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ECLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Scheduled Equipment Unscheduled Equipment Leased and Rented Equipment Installation Floater Limit In Transit Temporary Storage Project Name. DEDUCTIBLE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Dellbrook Construction LLC One Adams Place 859 Willard Street Quincy MA Limit Limit Limit 1,000,000 1,000,000 1,000,000 Deductible Deductible Deductible 1,000 1,000 1,000 ACORD 27 (2009/12) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
4 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COVERAGE PART. Name of Person or Organization: SCHEDULE Dellbrook JK Scanlan, the Owner and all other parties as required by the written contract with Dellbrook JK Scanlan.. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
5 POLICY NUMBER: CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COVERAGE PART Name of Person or Organization: SCHEDULE Dellbrook JK Scanlan, the Owner and all other parties as required by the written contract with Dellbrook JK Scanlan. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG ISO Properties, Inc., 2000 Page 1 of 1 ❷
6 POLICY NUMBER: CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COVERAGE PART Name of Person or Organization: Location And Description of Completed Operations: Additional Premium: SCHEDULE Dellbrook JK Scanlan, the Owner and all other parties as required by the written contract with Dellbrook JK Scanlan. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations ard". haz- CG ISO Properties, Inc., 2000 Page 1 of 1 ❷
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE.OF.LIABILITY.INSURANCE
CERTIFICATE.OF.LIABILITY.INSURANCE TIE R045 2/2/2018 DATE THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 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
More informationExhibit E-1: Insurance Requirements
Please produce separate Certificate(s) of Insurance for this project as detailed below: Certificate Holder: AllertonFox Construction LLC 110 W 40 th Street, Suite 1603 New York, NY 10018 CERTIFICATE# 1:
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/8/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationSPECIAL EVENTS INSURANCE REQUIREMENTS
Permit Center 210 Lottie Street, Bellingham, WA 98225 Phone: (360) 778-8300 Email: pwpermits@cob.org Web: www.cob.org/permits SPECIAL EVENTS INSURANCE REQUIREMENTS Permit Applicant: Give this memorandum
More informationSubcontractor Insurance Requirements
Subcontractor Insurance Requirements Project Name / #: Certificate Holder & Address: All Operations Back s Construction, Inc. 1602 Front Street, Suite 100 San Diego, CA 92101 Comprehensive General Liability
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORD CERTIFICATE OF LIABILITY INSURANCE Date (MM/DD/YR) Today s Date THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE OF LIABILITY INSURANCE
UMBRELLA LIAB EXCESS LIAB DED RETENTION CERTIFICATE OF LIABILITY INSURANCE OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE DATE (MM/DD/YYYY) 04/20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
More informationCONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F :
1 2 3 5 6 7 8 9 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE
More informationInsurance Requirement Sheet
Insurance Requirement Sheet To ensure optimal protection for our guests as well as our own organization we ask our guests to provide sufficient insurance coverage. Most organizations are already covered
More informationDocuSign Envelope ID: E7-5F1C-4156-BC4E C6B
INSURED CERTIFICATE OF LIABILITY INSURANCE COLUM-8 DATE (MM/DD/YYYY) INSURER A : National Fire Ins Co of Hartfo INSURER B : 20478 Midwest Employers Casualty Co INSURER C : INSURER D : INSURER E : INSURER
More informationUMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE DATE (MM/DD/YYYY) 11/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF I
UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE DATE (MM/DD/YYYY) 11/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
More informationYou can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation. Required Posting
30 W. Spring St. Colum bus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore,
More informationINSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 6/09/2014 THIS
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationTravel Demand Model Development and Improvements
Travel Demand Model Development and Improvements Volume II Cost Proposal submitted to Kalamazoo Area Transportation Study submitted by Cambridge Systematics, Inc. with Dunbar Transportation Consulting
More informationThe City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following:
DocuSign Envelope ID: 698692AA-34AA-4E87-B00D-5F810F0FFDD6 Financial Services Purchasing Division 215 N. Mason St. 2 nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing
More informationINSURANCE REQUIREMENTS
Exhibit C INSURANCE REQUIREMENTS ATTACH A COPY OF YOUR EVIDENCE OF INSURANCE MEETING ALL REQUIREMENTS 1.0 Mandatory Insurance Requirements Prior to commencing work, and until all obligations under this
More informationNote on Idaho Private Investigator License
Note on Idaho Private Investigator License Idaho is one of five (5) states in the U.S. that do not require and do not provide any government-issued licenses for private investigators and private investigation
More informationCONTRACTOR NETWORK. Application & Program Fundamentals
CONTRACTOR NETWORK Application & Program Fundamentals INTRODUCTION DCMG is extremely thorough in the credentialing process of our network members to ensure that our client base of insurance carriers, property
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORDTM INSURED INSURER A : Travelers Property Cas Co of America INSURER B : Travelers Indemnity Company INSURER C : Berkley Insurance Company INSURER D : Travelers Indemnity Company of CT INSURER E :
More informationCERTIFICATE OF LIABILITY INSURANCE
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
More informationVENDOR INSURANCE REQUIREMENTS
VENDOR INSURANCE REQUIREMENTS California State University, Northridge Foundation is a recognized auxiliary of the California State University, Northridge. Doing business with the CSUN Foundation requires
More informationIndustrial Equipment Campers Flat Beds Mobile Homes Heavy Equipment RVs Motor Homes Trailers
We are a repossession company that specializes in difficult and hard to locate recoveries. Our team of recovery agents and investigators will locate and secure your collateral in a timely and professional
More informationCERTIFICATE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) Month//Year PRODUCER SIR and WRAP Programs THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Insurnce Agent/Broker Name AND CONFERS NO RIGHTS
More informationCrandall Corporation. Permit Package
Crandall Corporation Permit Package May 2018 Prepared by Crandall Corporation UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION
More informationProposal For: 917 Alabama Avenue S. Bremen, Georgia Phone: (770) Fax: (770)
Proposal For: JEA Solicitation Title: The Point Meadows 230/26kV Substation and Transmission Circuits 946/956 Interconnect JEA Solicitation Number: 085-16 Silvey Proposal No. 16P028 917 Alabama Avenue
More informationArchitecture Historic Preservation Construction Management 224 South Michigan Avenue Suite 245 Chicago, Illinois 60604 312.922.2600 312.922.8222 Fax SMITH HARDING JV July 22, 2014 Ms. Jennifer Maul Risk
More informationCERTIFICATE OF LIABILITY INSURANCE
PRODUCER INSURED CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : FAX (A/C, No): A UMBRELLA LIAB OCCUR N N 793001413 6/30/2016
More informationNote on Alaska Private Investigator License
Note on Alaska Private Investigator License Alaska is one of five (5) states in the U.S. that do not require and do not provide any state-issued licenses for private investigators and private investigation
More informationCERTIFICATE OF LIABILITY INSURANCE
UMBRELLA LIAB OCCUR CERTIFICATE OF LIABILITY INSURANCE ECESS LIAB CLAIMS-MADE DED RETENTION 10,000 CUP8E78327A 7/15/2016 7/15/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EECUTIVE
More informationCONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : Gordon Chevrolet, Inc. INSURER C : 171 Great Road INSURER D : Acton, MA 01720 INSURER E : INSURER F : INSURER(S) AFFORDING
More informationSTATE OF ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD MONTGOMERY, ALABAMA
STATE OF ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD MONTGOMERY, ALABAMA LICENSE EXPIRES SEPTEMBER 30, 2019 RENEW LICENSE(S) BEFORE AUGUST 1, 2019 Confirmation Number: 20180725000010800 Renewal Period: June
More information[COMPANY INFORMATION]
2013 Damage Appraisers of North America [COMPANY INFORMATION] Contains coverage maps with rates, company Quick Facts, W-9 tax form, and copies of important corporation documents that could be of use to
More informationState of West Virginia Solicitation Response
Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130 State of West Virginia Solicitation Response Proc Folder : 388532 Solicitation Description : ADDENDUM 2 -
More informationCase KJC Doc 64 Filed 12/21/17 Page 1 of 16
Case 17-12913-KJC Doc 64 Filed 12/21/17 Page 1 of 16 UNITED STATES BANKRUPTCY COURT DISTRICT OF DELAWARE In re Dextera Surgical Inc., et al. Case No. 17-12913 (KJC) Debtor INITIAL MONTHLY OPERATING REPORT
More informationEFFECTIVE JULY 1, 2009
EFFECTIVE JULY 1, 2009 Los Angeles World Airport Special Endorsement forms will no longer be accepted. The only evidence of insurance accepted will be either a Certificate of Insurance and/or a True and
More informationState of West Virginia Solicitation Response
Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130 State of West Virginia Solicitation Response Proc Folder : 426521 Solicitation Description : Addendum 3-Williamson
More informationSUBCONTRACTOR QUALIFICATION FORM For J. RAYMOND CONSTRUCTION CORP
SUBCONTRACTOR QUALIFICATION FORM For J. RAYMOND CONSTRUCTION CORP 465 W. Warren Rd. Phone#: (407) 862.6966 On the Web at www.jray.com Longwood, FL 32750 Fax #: (407) 571.3597 Instructions: Elaboration
More informationBLUEPRINT 2010 ACORD CERTIFICATE OF INSURANCE CHANGES CONSTRUCTION PRACTICE LIKELY ISSUES CONSTRUCTION CONTRACTS
CONSTRUCTION PRACTICE BLUEPRINT September 2010 www.willis.com 2010 ACORD CERTIFICATE OF INSURANCE CHANGES Many of you have heard that ACORD, the licensing company for insurance forms, has amended their
More informationChad M. Buchanan, C.F.O. (260) , Ext Alan Scherer, Operations Department
To: Transportation Department RE: Logistics Packet Thank you for the opportunity to service your transportation needs. Attached are documents that will assist you in establishing Circle Logistics as your
More informationDecember 01, 2011 GREG CRAWFORD PURPOSE TRANSPORTATION CORP 8181 JETSTAR DRIVE SUITE 130 IRVING, TX 75063 CERTIFICATE OF STANDARD CARRIER ALPHA CODE (SCAC) ASSIGNMENT The Standard Carrier Alpha Code of
More informationCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFI
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationSOIL INVESTIGATION REPORT
SOIL INVESTIGATION REPORT Report Date: 11/9/16 Inspection Date: 8/25/16 Level of Study: 3 Site Location: 160 Monroe Drive, Lake Dow North, Lot 186 Job No. 16356.2 Client: Dave Aynes, Atlanta Leasing &
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationPurpose of Training. Disclaimer
Purpose of Training The Council of Contracting Agencies (CCA) Committee on Risk Management and Insurance recommends that public entities have a program of risk management and insurance so as to minimize
More informationCERTIFICATE OF LIABILITY INSURANCE
A A A B A- LOCKTON COMPANIES, INC. 85 AVENUE OF THE AMERICAS, STE. 200, NY, NY 0036 B- AON/ALBERT G. RUBEN & CO., INC. 5303 VENTURA BL., SUITE 200, SHERMAN OAKS, CA MISC EQUIP/PROPS SETS, WARD/3RD PARTY
More informationEVIDENCE OF PROPERTY INSURANCE
Quail Creek La Paz Condominium Association 29b Technology Drive Suite 100 Irvine, CA 92618- EVIDENCE OF PROPERTY INSURANCE THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY
More informationD.R. Horton, Inc. Vendor Insurance Requirements ALL STATES EXCEPT CA, WA, OR, ID, UT, AND HI
D.R. Horton, Inc. Vendor Insurance Requirements ALL STATES EXCEPT CA, WA, OR, ID, UT, AND HI For NEW VENDORS, your certificate should be returned to the division with your subcontractor agreement. For
More informationCERTIFICATE OF LIABILITY INSURANCE
UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under
More informationINVITATION TO BID RSU-21 Schools Additions and Renovations (Referendum 6-10) Bid Package Concrete - Mildred L Day School Sprinkler and Pump Room
INVITATION TO BID RSU-21 Schools Additions and Renovations (Referendum 6-10) Concrete - Mildred L Day School Sprinkler and Pump Room Project Information Project 14669: RSU-21 Schools Additions and Renovations
More informationOVERSIZE LOADS TYPES OF PERMITS ISSUED
City of Moreno Valley 14177 Frederick Street Moreno Valley, CA 92552 (951) 413-3140 OVERSIZE LOADS TYPES OF PERMITS ISSUED 1. Annual Permits are valid from the date of issuance to the expiration date not
More informationNOTICE OF AWARD. RE: Bid #4183RP-Painting & Pressure Washing Services-Contact Labor
LAKE COUNTY SCHOOLS Leading our Children to Success Procurement Services 29529 CR 561 Tavares FL 32778 (352) 253-6760 Fax: (352) 253-6761 http://lake.k12.fl.us Superintendent: School Board Members: Susan
More informationSubcontractor Insurance Requirements Certificate Holder VCI Construction, LLC 1921 W. Eleventh Street, Upland CA 91786
Subcontractor Insurance Requirements Certificate Holder VCI Construction, LLC 1921 W. Eleventh Street, Upland CA 91786 Provide this document to your insurance agent along with all samples of endorsements
More informationOVERVIEW TOP 24/7 CREDIT RATING 15,000+ APPROVED MOTOR CARRIERS CLIENT SUPPORT 1%
OVERVIEW 24/7 TOP CLIENT SUPPORT 1% CREDIT RATING 15,000+ APPROVED MOTOR CARRIERS ABOUT US Founded in 2005, D&L Transport is a leading transportation brokerage company offering exceptional freight brokerage
More informationDear Transportation Manager:
Dear Transportation Manager: As the transportation manager, I am sure you are always looking for qualified help moving your freight. We, at ST Freight, LLC are eager to show you the advantages we offer
More informationJune 22, To the Owners of. Solair Wilshire Homeowners Association 3785 Wilshire Boulevard Los Angeles, CA Re: Insurance Renewal
HUB International Insurance Services June 22, 2018 580 California Street, Suite 1300 www.hubinternational.com Phone: 415.276-2812 Lic. No. 0757776 To the Owners of 3785 Wilshire Boulevard Re: Insurance
More informationPARADE APPLICATION RULES
PARADE APPLICATION RULES 1. All applicants for entry are subject to approval and acceptance by the Parade committee. For applications to be considered, they must be completed and received by December 1,
More informationSummit Management Services, Inc. Vendor Management Program Requirements
Summit Management Services, Inc. Vendor Management Program Requirements I/we agree to provide goods and/or services for Summit Management Services, Inc. and/or properties managed by Summit Management Services,
More informationWASHTENAW COUNTY ROAD COMMISSION Permit Engineering Section 555 N. Zeeb Road Ann Arbor, MI 48103
WASHTENAW COUNTY ROAD COMMISSION The following is (1) a list of the activities which utility companies will be allowed to undertake in Washtenaw County road Right-of-Way under a Blanket Permit ; and, (2)
More informationWASHTENAW COUNTY ROAD COMMISSION Permit Engineering Section 555 N. Zeeb Road Ann Arbor, MI 48103
WASHTENAW COUNTY ROAD COMMISSION Permit Engineering Section The following is (1) a list of the activities which utility companies will be allowed to undertake in Washtenaw County road Right-of-Way under
More informationMC DATH
Carrier Profile Corporate Name: Dalor Transit, Inc. Established: 1976 Federal Employer Identification: 39-1332520 ICC Identification: MC 147312 US DOT Number: 168179 SCAC Identification Code: DATH Address:
More informationVendor Management Program (VMP)
1 Vendor Management Program (VMP) Dear New Vendor Partner, Thank you for your interest in doing business with Summit Management Services, Inc. As a premier national residential real estate company, Summit
More informationOctober 1, To all Owners of. 66 Cleary Court Condominium Owners Association 66 Cleary Court San Francisco, CA
CA DOI#0D08408 Tel 415.541.7900 Fax 415.541.7195 Toll Free 800.648.1600 October 1, 2012 To all Owners of 66 Cleary Court San Francisco, CA 94109 Re: Insurance Ladies & Gentlemen: Enclosed are the Evidence
More information1. REGISTRATION NUMBER 2. REASON FOR SUBMISSION (FDA Establishment Identifier)
12. HCT/Ps REGULATED AS MEDICAL DEVICES 11. HCT/Ps DESCRIBED IN 21 CFR 1271.10 DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE FOOD AND DRUG ADMINISTRATION ESTABLISHMENT REGISTRATION AND
More informationRudolph Libbe Inc Subcontractor / Vendor Prequalification Instructions
Rudolph Libbe Inc Subcontractor / Vendor Prequalification Instructions Introduction The following document provides an outline of information needed to complete the on -line subcontractor/vendor pre-qualification
More informationCERTIFICATE OF LIABILITY INSURANCE
COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X PRO- POLICY JECT LOC AUTOMOBILE LIABILITY EXCESS LIAB CLAIMS-MADE DED X RETENTION 10,000 WORKERS COMPENSATION AND EMPLOYERS'
More informationThe deadline for submitting this application is March 23, (Attach additional sheets if necessary) General Information:
The deadline for submitting this application is March 23, 2018. (Attach additional sheets if necessary) General Information: Organization name (as stated on IRS 501(c)(3) letter) Texas Legal Services Center
More informationCommitted to Excellence Procurement Services 29529 CR 561 Tavares FL 32778 (352) 253-6760 Fax: (352) 253-6761 http://lake.k12.fl.us Superintendent: School Board Members: Susan Moxley, Ed.D. District 1
More informationThe following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin
The following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin within the Vendor Self Service portal at wvoasis.gov.
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/03/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationNEW VENDOR INFORMATION
NEW VENDOR INFORMATION ENROLLMENT INSTRUCTIONS When you become a BH Management Compliant Vendor you are approved to offer your services to all properties managed by BH Management Services, LLC anywhere
More informationPer your request, the Village will revise the above-mentioned contract by reducing the amount of
VILLAGE OF ra slake z est. 1895 November 20, 2014 TGF Enterprises Inc. Mr. Tom Flader 530 North Avenue Libertyville, IL 60048 Re: 2014/2015 Snow Removal Contract Revision Dear Mr. Flader, Per your request,
More informationState of West Virginia Solicitation Response
Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130 State of West Virginia Solicitation Response Proc Folder : 332008 Solicitation Description : OSR Southern
More informationThank you for your interest in joining the LiteGear family!
1 Thank you for your interest in joining the LiteGear family! In order to set up your LiteGear Account, return the following items. Please note, that it may take up to 24 hours to process and verify all
More informationCITY OF ROHNERT PARK CITY COUNCIL AGENDA REPORT
Mission Statement We Care for Our Residents by Working Together to Build a Better Community for Today and Tomorrow. ITEM NO. 7C1 Meeting Date: February 14, 2017 Department: Development Services Submitted
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORD. Iient#: 131 DAVIFAR CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/26/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
More informationWORLDWIDE EXPRESS TRUCKLOAD
WORLDWIDE EXPRESS TRUCKLOAD 2017 Worldwide Express is your full-service FTL service provider, with offices across the nation available to help you identify the right solution at the right price, letting
More informationSCANA Corporation. AEGIS Insurance Services, Inc.
ESSENTIALS OF CONTRACTUAL RISK TRANSFER: INSURANCE ISSUES WITH CONTRACTORS, VENDORS, & SUPPLIERS David P. Abernathy, Esq. Vice President & General Counsel Spire, Inc. Bryony Bowers Hodges, Esq. Assistant
More informationEstablished in 2006, serving US and Canada with TL, LTL. Our team working 24/7 to provide all the support that you need.
Mailing Address :- PO Box 4 Syosset, NY, 11791. Phone :- 716-337-5000/516-874-0909. Fax :- 716-772-3383 Website :- www.alg.us.com Corporate HQ:- 68 S Service Suite #100, Melville, NY, 11747. (A freight
More information29. Cisco Technology Products
City Council Agenda 29. Cisco Technology Products Action: A. Approve contracts for providing Cisco technology products and services for the term of five years in the estimated annual amount of $2,000,000
More information18 November 2015
18 November 2015 No Search Results SAM Search Results List of records matching your search for : Record Status: Active DUNS Number: 015902943 Functional Area: Entity Management, Performance Information
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/26/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationFl POLICY [XJ JECT PRO- D LOC PRODUCTS - COMP/OP AGG $ OTHER: $ A-7CA /1/2018 7/1/20 19!Ea accidenll
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 7/1/2019 6/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
More informationANC 1B TRANSPORTATION COMMITTEE Thursday, November 19, :00-8:15 p.m. Columbia Heights Recreation Center 1480 Girard Street, NW AGENDA
ANC 1B TRANSPORTATION COMMITTEE Thursday, November 19, 2015 7:00-8:15 p.m. Columbia Heights Recreation Center 1480 Girard Street, NW AGENDA 3rd and U Street Curb Cut (DDOT Tracking # 118364) Presenter:
More informationCONTRACTOR LICENSING APPLICATION. Complete Separate Application for each License (CLASS A, B, C, D AND E)
City of Lawrence PLANNING & DEVELOPMENT SERVICES Building Safety Division PO Box 708 1 Riverfront Plaza, Suite 11 0 Lawrence, Kansas 66044 p. (785) 832-7700 f. (785) 832-3110 www.lawrenceks. org/pds buildinqinspections@lawrenceks.org
More information- DATE (MM/DD!YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
More informationCountrywide Express Inc.
Countrywide Express Inc. CUSTOMER APPLICATION At Countrywide Express our mission is to establish long lasting partnerships with customers in North America by providing best in class transportation solutions,
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 12/23/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
More informationCERTIFICATE OF LIABILITY INSURANCE
X X X A- LOCKTON COMPANIES, INC. 1185 AVENUE OF THE AMERICAS, STE. 2010, NY, NY 10036 B- AON/ALBERT G. RUBEN & CO., INC. 15303 VENTURA BL., SUITE 1200, SHERMAN OAKS, CA WOODRIDGE PRODUCTIONS, INC. MISC
More informationï
ï î í ì ë ê é è ç ïð ïï ïî ïí UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory
More informationTax ID: MC C SCAC: BWCD DOT:
Tax ID: 27-317881 MC-741798-C SCAC: BWCD DOT: 2129517 Blackwell Consolidation, LLC Mailing PO Box 3667 Central Point, OR 97502 Corporate Location 5656 Crater Lake Ave. Central Point, OR 97502 Hours: 7:00-5:00
More informationELITEPAC General Liability Extension
ELITEPAC General Liability Extension SUMMARY OF COVERAGES (including index) COMMERCIAL GENERAL LIABILITY CG 72 02 12 11 This is a summary of the various additional coverages and coverage modifications
More informationPremier Finance Adjusters
Premier 2016 Finance Adjusters Thank you for choosing Premier Finance Adjusters for all of your repossession needs. We have been servicing repossession needs in Pennsylvania for over 20 years. We seek
More informationPLUM BOROUGH MUNICIPAL AUTHORITY CONSULTING ENGINEERS WATER DEPARTMENT
PLUM BOROUGH MUNICIPAL AUTHORITY CONSULTING ENGINEERS WATER DEPARTMENT 2016 ANNUAL REPORT February, 2016 PREPARED BY: R. F. MITALL & ASSOCIATES, INC. ENGINEERS CONSULTANTS SURVEYORS 117 SAGAMORE HILL ROAD
More informationATLAS TRUCKING AND LOGISTICS, LLC
Atlas is a privately-owned common carrier based in Taylor, Michigan that delivers truck-load freight across the continental United States and Ontario, Canada. We have a team of company drivers in trucks
More information