CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

1 The ACORD name and logo are registered marks of ACORDCERTIFICATE HOLDER 1988-2014 ACORD CORPORATION. All rights 25 (2014/01)AUTHORIZED REPRESENTATIVECANCELLATIONDATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCELOCJECTPRO-POLICYGEN'L AGGREGATE LIMIT APPLIES PER:OCCURCLAIMS-MADECOMMERCIAL general LIABILITYPREMISES (Ea occurrence)$DAMAGE TO RENTEDEACH OCCURRENCE$MED EXP (Any one person)$PERSONAL & ADV INJURY$ general AGGREGATE$PRODUCTS - COMP/OP AGG$$RETENTIONDEDCLAIMS-MADEOCCUR$AGGREG ATE$EACH OCCURRENCE$UMBRELLA LIABEXCESS LIABDESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)INSRLTRTYPE OF INSURANCEPOLICY NUMBERPOLICY EFF (MM/DD/YYYY) POLICY EXP(MM/DD/YYYY) EACH DISEASE - EA DISEASE - POLICY LIMIT$$$ANY PROPRIETOR/PARTNER/EXECUTIVEIf yes, describe underDESCRIPTION OF OPERATIONS below(Mandatory in NH)OFFICER/MEMBER EXCLUDED?

2 WORKERS COMPENSATIONAND EMPLOYERS' LIABILITYY / NAUTOMOBILE LIABILITYANY AUTOALL OWNEDSCHEDULEDHIRED AUTOSNON-OWNEDAUTOSAUTOSAUTOSCOMBINED SINGLE LIMITBODILY INJURY (Per person)BODILY INJURY (Per accident)PROPERTY DAMAGE$$$$THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.

3 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID / A$$(Ea accident)(Per accident)OTHER:THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE : If the CERTIFICATE holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement.

4 A statement on this CERTIFICATE does not confer rights to thecertificate holder in lieu of such endorsement(s).COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:INSUREDPHONE(A/C, No, Ext):PRODUCERADDRESS:E-MAILFAX(A/C, No):CONTACTNAME:NAIC #INSURER A :INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :INSURER(S) AFFORDING COVERAGESHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.