Asfddddddddddd



Yüklə 67,77 Kb.
tarix07.01.2022
ölçüsü67,77 Kb.
#80588



ACORD CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YY)

09/01/12

PRODUCER

Jones & Jones Insurance Agency

125 Block Ave

Denver, CO 80202

THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.

INSURERS AFFORDING COVERAGE


INSURED

Rudy’s Muffler Shop

3 Broad Ave

Englewood, CO 80110

INSURER A: Worldwide Insurance Co.

INSURER B:

INSURER C:

INSURER D:

INSURER E:

THE POLICES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.




INS

LTR


TYPE OF INSURANCE

POLICY NUMBER

POLICY EFFECTIVE DATE (MM/DD/YY)

POLICY EXP DATE (MM/DD/YY)

LIMITS






GENERAL LIABILITY











EACH OCCURRENCE

$




 COMMERCIAL GENERAL LIABILITY










FIRE DAMAGE (any 1 fire)

$




CLAIMS MADE  OCCUR










MED EXP (any 1 person)

$




 _______________________










PERSONAL & ADV INJURY

$




 _______________________










GENERAL AGGREGATE

$




GEN’L AGGREGATE LIMIT APPLIES PER:










PRODUCTS – COMP/OP AGG

$




 POLICY  PROJECT  LOC


















AUTOMOBILE LIABILITY











COMBINED SINGLE LIMIT

(Ea Accident)



$ 750,000




 ANY AUTO
XYZ7777

9/1/11

9/1/12




 ALL OWNED AUTOS











BODILY INJURY

(per person)



$




SCHEDULED AUTOS










 HIRED AUTOS







BODILY INJURY

(per accident)



$




 NON OWNED AUTOS













 _________________










PROPERTY DAMAGE

(Per accident)



$




 _________________












GARAGE LIABILITY











AUTO ONLY – EA ACCIDENT

$




 ANY AUTO










OTHER THAN

EA ACC

$




 _________________










AUTO ONLY

AGG

$



EXCESS LIABILITY











EACH OCCURRENCE

$




 OCCUR  CLAIMS MADE










AGGREGATE

$




 DEDUCTIBLE













$




 RETENTION $______________













$



WORKER’S COMPENSATION AND











 WC Statutory Limits  Other







EMPLOYER’S LIABILITY










E.L. EACH ACCIDENT

$
















E.L. DISEASE –EA EMPLOYEE

$
















E.L. DISEASE –POLICY LIMIT

$


OTHER


Hired Auto Physical Damage

XYZ7777

9/1/11

9/1/12

$50,000 $100 Ded. Comp. Collision $250 Ded. Coll.

DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS:

Avis Budget Group, Inc. and its Subsidiaries including Avis Budget Car Rental, LLC, Budget Rent A Car System, Inc. and Budget Truck Rental, LLC, and any other party or vehicle owner who may be held responsible for the operation, maintenance, and use of the rental vehicle are included as Additional Insured’s ( Loss Payee**). Coverage is extended to include all vehicles leased, rented or supplied as a substitute or as an additional vehicle to the named insured.




CERTIFICATE HOLDER [N] ADDITIONAL INSURED; INSURER LETTER: __Y____ CANCELLATION

Avis Budget Group, Inc. and its Subsidiaries

C/O: Budget Truck Rental, LLC

PO Box 690360Tulsa, OK 74169-0360

SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _______ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.

AUTHORIZED REPRESENTATIVE

ALFRED JONES



Yüklə 67,77 Kb.

Dostları ilə paylaş:




Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©muhaz.org 2022
rəhbərliyinə müraciət

    Ana səhifə