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·ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) <br />~ 11/2/2020 <br />THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTJFICATE 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 />'PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. -· . ...__,,>ORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) 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 lleu of such endorsement(s). <br />PRODUCER ~2~~~CT Heidi Lewis <br />Scirocco Group ~.l!~NJA "-"· 201-727-0070 X153 I FAX 777 Terrace Avenue iAJC Nol: 201-727-0080 <br />Hasbrouck Heights NJ 07604 it'D~~s: hlewis@sciroccoaroup.com <br />INSURER/SI AFFORDING COVERAGE NAIC# <br />INSURER A: Selective Fire & Casuattv Ins 14377 <br />INSURED PLCUS-1 INSURERB: PL Custom Body & Equipment Co Inc INSURERC: 2201 Atlantic Avenue <br />Manasquan NJ 08736 INSURE.RD: <br />INSURERE: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: 1310852112 REVISION NUMBER: <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. NOiWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY SE 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 />INSR TYPE OF INSURANCE ADDI. SUBR ,~g'il,gr""'~' ,&g~~'fv~, LIMITS LTR l,.l<>n lwvft POLICY NUMBER <br />A x COMMERCIAL GENERAL LIABILITY S1890473 5/5/2020 5/5/2021 EACH OCCURRENCE $1.000,000 -D CVJMS-MAOE 0 OCCUR <br />DAMAGE TO RENTED PREMISES 1ea oec:urren~l $500,000 -MEO EXP !Any one oorsonl s 15.000 <br />PERSONAi. & AOV INJURY s 1.000.000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Fl POWCY o m?i 0 LOC PRODUCTS· COMP/OP AGG $2,000,000 <br />OTHER: $ <br />~ COMBINED SlNGLE LIMIT \UTOMOBll.E UABIUTY $1890473 5/5/2020 51512021 1ea accident\ $1,000,000 -·~ x AAYAUTO BOOll. Y IWJURY (Per porson) $ <br />-OWNED ~SCHEDULED <br />AUTOS ONLY AUTOS BOOll. Y INJURY (Per accident) $ <br />-HIRED x NON-OWNED rp~~~~~8AMAGE x AUTOS ONLY AUTOS ONLY $ -x Dealerfllales $ <br />A x UMBRELLA LIAS 1210CCUR $1890473 51512020 515/2021 EACH OCCURRENCE $9,000,000 -EXCESSUAB CL.AIMS.fv!ADE AGGREGATE $9,000,000 <br />OED I x I RETENTION$" $ <br />WORKERS COMPENSATION I ~~~TUTE I I OTH· <br />AND EMPLOYERS' LIABILITY ER <br />YIN ANYPROPRIETORIPARTNERIEXECUTillE D NI A. E.L EACH ACCIDENT $ <br />OFFICERIMEMBEREXCLUOE07 <br />(ll!andatory In NH) E.L DISEASE-EA EMPLOYEE $ <br />11 '{J;s. describe under <br />O CRIPTION Of OPERATIONS below E.L.. DISEASE· POLICY LIMIT $ <br />A Garage Keep9rs 51890473 51512020 515/2021 Limit 4.000,000 <br />ded 500 <br />OESCRIPT10N OF OPERATIONS I LOCATIONS I Vl:HICLES (ACORD 101, Addlllonal Rem3rb Scl!adule. may be attached If more ~paco Is raqultad) <br />One or more 2020 or newer emergency medical vehicle <br />CERTIRCATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. <br />-..... .. 227 West Jefferson BLVD <br />13th Floor Room 1308 AUTHORIZED REPRESENTATIVE <br />South Bend IN 46601 ~µ./--fl <br />I <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD