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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:
<br />CONTACT
<br />(A/C, No):
<br />FAX
<br />E-MAIL
<br />ADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):
<br />PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />ER
<br />OTH-
<br />STATUTE
<br />PER
<br />LIMITS(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />POLICY EFF
<br />POLICY NUMBERTYPE OF INSURANCELTR
<br />INSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />$PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-
<br />JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />25674
<br />37532
<br />X
<br />D
<br />A
<br />B
<br />1,000,000
<br />1,000,000
<br />X
<br />Evidence of Insurance
<br />59814589
<br />59814589
<br />Jefferson, NC 28640
<br />5,000,000
<br />XS 3403394
<br />TJ-BAP-9P529118-TIL-20
<br />X
<br />1,000,000
<br />07/17/2020
<br />X
<br />X 5,000,000
<br />300,000
<br />GREAT AMERICAN E&S
<br />AXIS SURPLUS INS CO
<br />PL 3403401
<br />TRAVELERS PROP CAS CO OF AMER
<br />GREAT AMER E&S INS CO
<br />npielmeier
<br />C
<br />07/01/21
<br />07/01/21
<br />X
<br />Excess Liability
<br />Garage Keepers Liability
<br />Limit
<br />Limit
<br />07/01/21
<br />1,000,000
<br />,
<br />Hays Companies
<br />B
<br />4,000,000
<br />X
<br />2,000,00007/01/20
<br />1200 North Mayfair Road, Suite 100
<br />07/01/20
<br />07/01/20
<br />165 American Way
<br />07/01/21
<br />1,000,000
<br />TC2J-CAP-9P529106-TIL-20
<br />B
<br />B
<br />American Emergency Vehicles
<br />5,000,000
<br />07/01/20
<br />5,000,000
<br />Milwaukee, WI 53226
<br />UB-6P677889-20-51-K (AOS)
<br />UB-5P807980-20-51R AZ,MA,WI
<br />07/01/20
<br />07/01/20
<br />07/01/20
<br />07/01/21
<br />1-414-443-0000
<br />4,000,000
<br />P-001-000123735-02
<br />07/01/21
<br />07/01/21
<br />26620
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