263-22 Proposal - GPI.pdf

SECTION 4 Sample Insurance Certificate ae DATE (aEORTN) ACORD CERTIFICATE OF LIABILITY INSURANCE . 1228/2021 THIS GERTIFICATE 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 ceriificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER PRTIET ott Kazarehy BS Gonak roupltc [Pen teen Eno, Siao.008 SUITE 409 SalREss. jkozarsky@genatigrp.com NEW HYDE PARK NY 11042 __INSURER|S) AFFORDING COVERAGE wale msurera: Starr Indemnity & Liability Company 38318 sure rcenuns| 7 = Greanman Pedersen, Inc (Morris Piains) iene Beenie Menrance Compa es S01 Gibralter Drive, Suite 2a misuReR c: Westchester Surplus Line Insurance Company 10172 Mors Plains NJ 07950 tsuneR b: Berkley Insurance Company 32603 wsunen e. Everest National Insurance Company 10120 IsuRER ‘COVERAGES CERTIFICATE NUMBER: 111294500 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIGY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS. CERTIFICATE MAY E 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 SHCWN MAY HAVE BEEN REDUCED BY PAIO| CLAIMS, hed {TYPE OF INSURANCE ‘sp ww POLICY NUBER LEROY RIES TY, Ts ‘*_X_CONNERCIAL GENERAL LAGICTY 700002863321 veaw202| 12av202 excwoccunmence | $1,000,000 ciaussmor % occur DAWAGE TERENTED | 00,000 Conacutaa HEOEXE ny are oxson | 510,000 _ PERSONAL sADviNwURY | $1,900,000 GEHL AGGREGATE UNAT APPLIES PER ceversLaccresats | $2,000,000 poucr X TBF _X toc PRODUCTS COMPIOP ACG | $ 2,000,000 ore = 7 AUTONOBLEUABLITY 1000188598211 Taaw2can swavaone GT EREDSMOTEUMT Ts

,900,000 GEHL AGGREGATE UNAT APPLIES PER ceversLaccresats | $2,000,000 poucr X TBF _X toc PRODUCTS COMPIOP ACG | $ 2,000,000 ore = 7 AUTONOBLEUABLITY 1000188598211 Taaw2can swavaone GT EREDSMOTEUMT Ts 000,000 Ate auTO BOOLY JURY (ar pason) |S ED scueonen ALY UR (Par aco SUSE Owy Ce soot nae = fines Frater ROPERTY DAVACE XK MR ony AX AUTO eracedert — =f s © UWBRELLAUAS—_X occu 71780288009, Wegvz0a1 1251207 excwoccunnence | 510,000,000 XOSexOIS 12211 vesvanat 123172022 BCESSLAD cuamssnace AGGREGATE $10,000,000 ep _X_Re=045 spon | $ WORKERS COMPENSATION Ton000783 warn aoe Bian A (am EMO eRs LABRITE ww ‘oao0026a1 Weavaoa! Teavane ~ Stare ANYEROPNE ORPARTHEREXECUTE | evecuscooar | 1000000 Sere cuReN ea Beae na | thonaatory nt EL DISEASE. £4 SP. S7ER| 5 1,000,000 DESGRITSN OF SPERATIONS plow EL DISEASE. POUCY LNT | $ 1,000,000 Z Foye ‘uooas2z00%4a2"8 waava0a1 —pavean 3250.000 5 Prfelona vasiny ‘AEC-605031302 Weavenet 12912025, $1 000,000 $2 000000 ‘DESCRIPTION OF OPERATIONS / LOCATIONS VEHIOLES (AGORD 101, Additonal Remaras Scheful, may ba atached Wrere Space ls Faqured) (CERTIFICATE HOLDER CANCELLATION 30 day notice applies S A M P L E ‘SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Be eran, oe arco sate FOR INFORMATIONAL Sea PURPOSES ONLY Wh. be ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD. GPI Sample Insurance Certificate | Page 1