HomeMy WebLinkAboutINS CERT 2008-01-31
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P.O. Box 1745 * Windsor. CA 95492 * Phone: (707) 836-9200 * Fax (707) B-3':' IJ';1V
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'PRODUCER
Cassio Insurance Agency
PO 80)( 188
Simpsonville, SC 29681
(864) 688-0121
TM CERTIFICATE OF LIABILITY IN_~U~AN~~ .~~_ .
THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALiER THE
COVERAGE AFFORDED BY THE POLICIES BELOW
_I. ''''''''''''''_''_'''''''',''__ ,_INSURER~.~~~?~.~I~G C~~E,~GE
: INSURED A: :The Burlington Insurance Company
t-._._.~._" .'. .. .. __ .._._._.__
INSURED 8: ;
INSURED c: !
'j NSURED 0: :
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DATE (MMICDfYY)
1131J20oa
INSURED
----.j
!1I\iSLiREO"E:'j
,A
GENERAL LIABILITY
IxJ COMMERCAL GENERA_ LIABILITY
L U CLAIMS MADE U OCCUR
L
.CJ
GEN'L AGGREGATE LIMIT APPLIES PE
iXJ POlev ~ PR~ ~ LaC
JEeT
HGLC017891
1f2S12008
1/2812009
Personal/ Advertisers Liabjlity
Each Occurrence
Aggregate
Productsl Completed Operations A
Damages t~ Premises Rented to Y
Medical Expenses
Deductibre
$1,000.000
$1.000.000
$2.000.0001
$2.000.000
$50,000
55.000'
55.000
AUTOMOBILE L1ABfUTY
C ANY AUTO
C ALL OWNED AUTOS
[j SCHEOULED AUTOS
i ~ HIRED AUT:JS
~ NO~OWNED AUTOS
o
[J
GO\tBINED SINGLE LIMIT
(Ea acciderlt)
aODIL Y INJURY
!(per Person)
s
BODILY INJURY
(Per accident)
_I $
$
PROPERTY DAMAGE
{Pe- accident,
s
Ln
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l-
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GARAGE LIABILITY
o ANY AUTO
C
-t
i~-j
J --____ .
AUTO ONLY - EA AC:IDENT s
OTHER THAN EA ACe $
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E,L:._EA~tt !\CCIDENT . S
E.L..DISEA~~ -:EA~r...PLQY~E ~
!,.L. DISEASE - POLlCY~_____:__
.j
EXCESS LlA8tllTY
=:J OCCUR L.J CLAIMS MADE
~ DEOUCTIBLE
o RETENTION S
WORKERS COllAPENSATION AND
EMPLOYER'S L1ABUTY
!
, ---+-
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OTHER
DESCRfPTION OF OPER.~ TIQNS/LCCA TlONSNEHICLESlEXCLUSIONS ADDED BY EN)ORSEMENTISPECIAL PROVISION
Amusemenls devices on file with corr pany lor special slI9nts dsled througholll policy period only IOCQted at jiburon Blvd.: BlackiesPasture; jiburoll CA 94920.
Cel1lficate Holder As Additional Insured
i
CERTIFICATE HOLDER
CANCELLA TJON
~ - . .1 _ __~
.SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
,BEFORE THE EXPIRATION DATE THREOF. THE ISSUING INSURER WILL
iENOEAVOR TO MAil 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE
'HOLDER NAMED TO THE LEFT. BUT FA~E TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KINp UFj THE INSURER, IT'S AGENTS
OR REPRESNETA TIVES .
. J~UTHORIZE~.~.~PRESENTATIVE
! Town ofTiburon
Ann Danforth
)i 1505 Tiburon Blvd.
jjbtJron, CA 94920
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ACORD 25 (2001/08)
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