118-18 Attachment (1).pdf

aaa DATE (MNIDDIVYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE —— 04/26/2018 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 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 endorsements(s). PRODUCER Keystone Risk Partners LLC CONTACT NAME: 604 East Baltimore Pike PHONE (A/C, No, Ext): 888-473-6398 FAX (NC, No} MediaiP/s, 19068 E-MAIL ADDRESS: Risk@ExtensisGroup.com INSURERS AFFORDING COVERAGE NAICH INSURER A: Indemnity Insurance Company of North 43575 INSURED INSURER B: American Guarantee & Liability - Zurich 26247 Extensis IV, Inc. LICIF RSORERC: PAULUS SOKOLOWSKI & SARTOR LLC (PS&S, LLC) ~ 900 US HWY 9 North, Suite 203 INSURER D: Woodbridge, NJ 07095 NSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TNSR ‘ADD'L] SUBR POLICY EFF POLICY EXP UR TYPE OF INSURANCE insRo| wvo POLICY NUMBER camuopivyyyy_|_wmwooivyvy) Lis, ‘GENERAL LIABILITY Not Applicable EACH OCCURRENCE 8 I] [DAMAGE TO RENTED: | _|COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) | § cams woe [ _Joocur EDEXP anyenopenen) | § PERSONAL & ADV INJURY $ | GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER PRODUCTS.comPioP AGG | § | Jroucy | ]ERo" Loc $ MEINED SINGLE LIMIT | AUTOMOBILE LIABILITY Not Applicable ee ecagen $ ANY AUTO BODILY INJURY (Perperson) | § A OMe LHe BODILY INJURY (Per accident)| § ; NON-OWNED

omPioP AGG | § | Jroucy | ]ERo" Loc $ MEINED SINGLE LIMIT | AUTOMOBILE LIABILITY Not Applicable ee ecagen $ ANY AUTO BODILY INJURY (Perperson) | § A OMe LHe BODILY INJURY (Per accident)| § ; NON-OWNED PROPERTY DAMAGE HIRED AUTOS aoe (Per accident) S x ] UMBRELLA LiaB] x JoccuR UMB 5499247-04 09/30/2017 | 09/30/2018 | FACH OCCURRENCE $ 10,000,000.00 B EXCESS LIAB CLAIMS MADE AGGREGATE $ 10,000,000.00 x [oeo | x [RETENTION $10,000 § WORKERS COMPENSATION x | MOSTATE, | OTR} AND EMPLOYERS’ LIABILITTY 64762679 09/30/2017 | 09/30/2018 TORY LIMITS ER A. |ANY PROPRIETORIPARTNERIEXECUTIVE EL. EACH ACCIDENT $1,000,000. OFFICERIMEMBER EXCLUDED? YIN | N/A {Mandatory NH) EL.DISEASE-FAEMPLOYEE | $§ — _1,000,000.00 I'yes, describe under DESCRIPTION OF OPERATIONS belo EL.OISEASE-POLICYLImiT | $ — 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks, Schedule, if more space Is required) i! 3 Emergency Power Generators CERTIFICATE HOLDER CANCELLATION 8001 ‘SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Township of West Orange ACCORDANCE WITH THE POLICY PROVISIONS. 66 Main Street AUTHORIZED REPRESENTATIVE West Orange NJ, 07052 say Poi ee < Gl Y D © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD