|
_ �i
<br /> i
<br /> , i '
<br />' ��,°e....x�,�l � - I .
<br /> I''�"�L'��U� • �1;:l+1+�11 F. Y Il�ll�� 19 � `i,rl+� ��:r"�L�li 17�.� C � �C Wl�J7�;f1 il 4���w.b+� � DATC-(MMIDDIYYYY) .
<br /> I.� ��� ' S/23/201�F �
<br />'r�•fIS CfEf��'IrYGA7L IS I��UL=.L7 AS A IVI/1'f'I'�!7 OE= INFOI;MA7'IOFI ONLV AP�p CONf'L=C:5 f�0 RIGFI1'S Uf'OiV fl-IL=.CEf�71FIC/�7'E HOLDCh. 1'I-IIS
<br /> CChY11FIC/�7C bOrS iV01 API'IP�MAYIVELY Ofi N�GA7IVELY AMEND, GlC7END 0� AL7ER TIiC COVErAGC APfORDGD aY TFIF POLICI�S
<br /> Ei�LOW, ,�'I�B�S CEP�7IFICA7C Of INSUI:ANCC bOCS �107 CON.gTITU7E Ai CONTR/1CT F3CTVIfC[N TIiC ISSUING IP1,�iUR[h(S), AUTI-IORI�CD
<br /> d��P�E3EN7/�TIVE OI�B'f�ODUCFI:;AP�D TWE CER7IFICATG NOLDER. � .
<br />�fUi�O�7IA`�f'9':� If lhe�srti�icaCe liolder is ai�AL7DI'i'ION!�L IPJ5UI:C�,ihe policy(ies)must be enclorseci. If SUBR�GE1710N 15 WAIVi�D,subject to
<br /> Iro�e term:�ancB conclitions of the policy,certain nolicies may require an endorsement. A statement on tl�is certific�te does no4 confer ric�lits to tlie
<br /> erQi�icat�I�nfc3c�r in lieu a��ucli endorsemen��. '
<br />_�:�.-�.-...._..:o_,..,,._.:,�:.._.:�...,...:_,..ss....:,.......,..:.�........��..:..�:...S..P.,-.._,_�.�,:���,.,.,,�a:_v:� �
<br /> .u�,.,.�... _�oai'nci=�r�.._�,.-.a.z.,...:...=:,s.-._ _ ��,�---- �
<br /> o:�c�i:_ �-s---—.,e.,�n�,�.,�,- -
<br /> tfOtl �'-.C1II�C,�I1P.1' PIIONE � ---
<br /> E Cl��vclantl Ce��fe�-; 1=100��Q ec�n,��n:2.16-65F�1100 ---- (a�c�r�oi.21E;-�a�-Z121._.
<br /> 5 l=ast 9th St�'eet . r_-NrAU_ _
<br /> noorzess:
<br />��Li�:r�ci��i-i����� 1<I �
<br /> . IMSUF2 lP15URFli!8)O.FI'ORD!l�IU CO�IFHA[iE �� !y:U('i.�
<br /> � �-- _ __.� _�
<br /> --�---------.._._......__ ._ -----.._._.._..--�----� -_._.___._ c ERA:r1/_P.rP.St JCIS��'ITIIIIIV I(1_xl1��f�,C_P.C;n,--
<br /> r:rsn ` , __ -----------__ -=----— —LR5�
<br /> uasunrra a:j-yPrPSt I�latinn�l in5i ir7nr�_C;nnin�ny__�_��•���___�
<br />:ixy 1=irFwnri<s.h7r.. _ ,
<br />• L..Martin !_ii(her 4Ci::c,�f�lvd iri.,uan_c Ahl�?1L�?IlJ�ILj�C�17ln�n�,i_ ----- p' � ---,
<br /> � nusuii —�C_B�Q----
<br /> r�p� t-L 93�i0:, ' - �Rn:
<br /> -- --�-......------_.._.._. ..- ---
<br /> � _._._ _ ------ �- -
<br /> , irJSURER E� • - ,
<br /> uasu�erz F: `
<br />�����'�1-� CCf7711=1C/kT�PJUfUIC�C�t:'1172G.2�E5'I'I I REi/9�I�N ftlUIVIBER:
<br />-IIS IS TO CLRTII=Y 7FIA'f TI-IG POLICICS 01=INSU�ANCC LISTCD DCLOW I�IAVC D[�N ISSUED TO TI-IC INSUR[D NAMCD AE30VE f'OR"fl-IC POLICY PERIOD
<br /> 1DICATCU. I�1011NITl-ISTAf�lDI�1G AhIY REQUIRCMEPIT, TERM OR CONDITION OF ANl'CO�ITRACT OR OTFIER DOCUMENT.WITH P.ESPEC7 TO WI-IIChI ThIIS
<br />-RTIFICATE MAl' f3F ISSUI=D OR MAY P[RTAIN, ThIG I�ISU�A�ICE AFFORDED DY�THE POLICIES D; . [I?GIN IS SUDJC-CT TO AI_I_ THE TGRMS,
<br /> CCCUSIOIV$Af�ID CONDITIOh1S 01=SUChI POLICIES.LIMITS SFIOWN MAY hIAVE BE[N�EDUCED BY ID CLAIMS. ��� �
<br /> aoo�su�e ' -
<br /> 7YPG 01'INSURA{VCE POLICY EF � OCICY�7E `
<br /> INS12 WVD POLICY NUMRBR fMMIDDIY - MMIDDIYYY LIMITS
<br /> GkPJL=I211L LIA61LI1'Y Y GI_Bin�lef /'10/201 /'1012015 '
<br /> EACI-I CCURR[NCE $'I,000,000
<br />�� COMA�9ERCIAL GEN[RAL LIFlF3ILITY DAMA E TO R[NT[D �
<br /> (X � P}3E S�S fE�occurrence $500,000
<br /> CI.AIMS-�AAf1E �•- �OCCI.IR ME EXP An one erson
<br /> . R
<br /> . P=RSONAL&ADV INJURY $1,000,000
<br /> • G[NERALAGGREGATE $2,000,000 '
<br /> G[N'L AGGREGA7E LIMITAPPLICS'P[R: - � i PRODUCTS-COMP/OP AGG
<br /> POLICY �R� . �� LOC $2,000 000� . .
<br /> �
<br /> AUi'�MOBILF LIABILIYY Y �Auto Dinder ` 1/10/2014 /'10/20�15 COMBINED SINGLE LIMIT
<br /> Ea acc(denl 1,000 000
<br /> ANY AUTO I BODILY INJURY(Per persan) $
<br /> ALL OWNCD SCHEDULED �
<br /> Al1TOS NON-OWNED � BODILYINJURY(Peracetdenl) $
<br />� FIIRED AUTOS �� AUTOS ; PROP[RTY DAMAGE �
<br /> j Per accident $
<br /> !. � i
<br /> UMBRCLLA LIA� X ' OCCUR Y [AU753'159 . /'10/201q 'PI012015
<br /> F)(CESS LIAB ; EACI I OCCURRENCE �4,000,000
<br /> CLAIMS-MADE
<br /> AGGREGATE ' $4,000,000
<br /> DED . RETENTION$ - _
<br /> OFKERS COIVIPCNSAI'ION S
<br /> WC STATU-
<br /> IdD EMNLOYERS'LIA�ILI7Y Y�� � OTH-
<br /> NY PROPRIETOR/PARTNER/EX[CLITIVE i -
<br /> 1=FICER/M6MBER EXCWDED7 � N I d ' i E.L.EACH ACCIDEN"i ' �
<br /> Mandatory in NIi) � � , '
<br /> f yes,describo under E.L.DISEASE-EA EMPLOYE- $ -
<br /> ESCRIPTIOIV OF OPERATIONS below � E.L.DISEASE-POLICY LIMIT
<br /> -- $
<br /> i
<br /> - . -- —...�.�<:�___----- I I � '
<br /> IF"fION t�P OPL-12l1'lI0fV5!LUCA i IGWS I V[1IICL�S (Attach ACURD�101,Additional Hemarlcs ScheUule,I(more space is requtred� 'T""�'—""""'-'°•'--I
<br /> 1_()I.CItIVII. J�i•�J�JJI.)Vc111�J�VII:LC�JI��I�I���J� 1�iJ`��! I .
<br />�IIc1I II I�111'61.I: Ci1L�/UI LC�JI I)/jIIIIIS�Fascu Couiity f3uar'�I ui C;uurii.y Curnn�ii5siuner5, iVlaric F�yer dncl all iheir'agerd.s,r�r�resen[a�tives and
<br /> ilarie�> � I
<br /> - ' � ' i
<br /> . , , , .
<br /> �
<br /> Bi=1�C;lz�rL f-Yt3@_83@:ft ____ ..._�_._.___ _._.. �`�!i`dCY�l.�,d�"fIt1PJ �
<br /> �� , ' I
<br /> �!IOUL�J�hJY OP IlfE�;dOVE D[SCRIL�D f�OL1CIES n�ChPlCL!_LEn G+L1=01;C� � '
<br /> 71IG CXPIRa710N nnrr l"I•fE1Z[OP, NOTICE WILL .CiC DCLIV[R[D IN I
<br /> �Ify'U'��2�)�lyf�11��5, ��a3C0 CuUllly F3u�C'C�U(GUUllfy ACCOIi�ANCL=WITH'fH[:pOIJCI'pIZOVISI�fJS. �
<br /> Cnn•irriissionars a�icf Maiic ti,ier
<br /> 7�16? l;eading I:d.�3uite 7�0
<br /> Cincinnati OI-I�4523I AUl'HORIZEO RC-PRESGN"fATIVL
<br />______._J�....w...�.._......m�..._.._...�..... �f�;r•�-�:�x��;���,
<br /> _ ..�_.._��.__W._.. ,_...,� �I
<br /> � O•i96G�20901��O�D COf�POt�A,TION. .414�-igit4s���se�'vecl.
<br /> �5(20�1010:i) lrhe.�corD d,a�e�u�e��ocyo are rne�ist�e�•e�mar�«n¢�ar.n�n . ,
<br /> � i � , -
<br />
|