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ALTERNATE EMPLOYER ENDORSEMENT This endorsement applies only with respect to bodily injury to your employees while in the course of special or temporary employment by the alternate employer in the state named in Item 2 of the Schedule. Part One (Workers Compensation Insurance) and Part Two (Employers Liability Insuranc... | 2 |
XL XL CATLIN Regulatory Office 505 Eagleview Blvd., Suite 100 Dept: Regulatory Exton, PA 19341-1120 Telephone: 800-688-1840 COMMERCIAL LINES POLICY COMMON POLICY DECLARATIONS NOTICE: THIS POLICY IS ISSUED BY AN INSURER NOT AUTHORIZED TO DO BUSINESS IN KANSAS AND, AS SUCH, THE FORM, FINANCIAL CONDITION AND RATES ARE NOT... | 2 |
United Educators Item 7. Applicable Initial Endorsements: Excess General Liability attached Endorsements Endorsement Total Description GLX512A 1 GLX - Employee Benefits Liability (Claims-Made) GLX643L 1 Amended Limit of Liability (Annual Aggregate and Defense Outside Limit of Liability) GLX692G 1 GLX - Policy Correctio... | 0 |
AAIS This endorsement changes CU 0733 09 10 the policy Page 1 of 1 -- PLEASE READ THIS CAREFULLY -- EXCLUSION -- ATHLETIC OR SPORTS PARTICIPANTS COVERAGES E AND U The Commercial Excess/Umbrella Liability Coverage is amended as follows. All other "terms" of the policy apply, except as amended by this endorsement. COMMER... | 2 |
ANNUAL MEETING NOTICE Your policy includes a statement regarding membership rights in the Liberty Mutual Holding Company Inc. Liberty Mutual Fire Insurance Company is a Massachusetts stock insurance company subsidiary of the Liberty Mutual Holding Company Inc., a Massachusetts mutual holding company. Insurance is provi... | 2 |
AIG SPECIALTY INSURANCE COMPANY (A Capital Stock Company, herein called the Company) 175 WATER STREET NEW YORK, NY 10038 COMMERCIAL EXCESS FOLLOW FORM DECLARATIONS POLICY NUMBER: PROU 1920977 RENEWAL OF: 1920977 Item 1. NAMED INSURED: TERRACON CONSULTANTS, INC ADDRESS: 18001 W. 106TH STREET, SUITE 300 OLATHE, KS 66061 ... | 2 |
CHUBE U.S. FOREIGN ACCOUNT TAX COMPLIANCE ACT ("FATCA") The U.S. Foreign Account Tax Compliance Act, commonly known as "FATCA", became the law in the U.S. in March of 2010 and becomes effective July 1, 2014. Pursuant to FATCA, brokers, producers, agents and/or clients may need to obtain withholding certificates from in... | 2 |
POLICY NUMBER: 37 UEA AA2667 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM COMPUTATION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART (1) The Advance Premium set forth... | 2 |
SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 37 WE BP6053 Schedule Number: 01-37-01 Effective Date: 01/01/14 Effective hour i... | 1 |
ENDORSEMENT # This endorsement, effective 12:01 a.m., December 30, 2018 forms a part of Policy No. US00088723LI18A issued to Polarville Cold Storage, LLC dba Coldco Logistics by XL Specialty Insurance Company. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS CHANGES This endorsement modifies insu... | 2 |
WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 01-2021) Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Re... | 2 |
COMMERCIAL AUTO CA 01 13 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO CHANGES For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, Colorado, this endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINES... | 2 |
COMMERCIAL AUTO CA 99 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE CLAUSE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, th... | 2 |
Policy Number AS2-641-444149-054 FORMS INVENTORY COVERAGE FORMS PARTS AND ENDORSEMENTS FORMING A PART OF THIS POLICY AT INCEPTION: Listed below are possible coverage forms and the states in which they apply. CA 00 01 03 06 FL, HI, VA CA 00 01 03 10 AK, CT, MA, NY, PR CA 00 01 10 13 AL, AR, AZ, CA, CO, DC, DE, GA, GU, I... | 0 |
SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: TWIN CITY FIRE INSURANCE COMPANY Company Code: 7 Policy Number: 37 WB BN3284 Schedule Number: 01-40-01 Effective Date: 10/01/13 Effective hour is t... | 1 |
COMMERCIAL GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ADJ. NO. Everest Indemnity Insurance Company NAMED INSURED DATE POLICY NUMBER Time & Alarm Systems Inc 05/31/2020 51GL008096-201 CLASS CODE PREMIUM BASIS PREMISES / OPERATIONS 91127 Gross Sales LOCATION EXPOSURE All 30,000,000 RATE PREMIUM... | 1 |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FELLOW EMPLOYEE COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM Under Section II - WHO IS ... | 2 |
NOTICE TO TEXAS POLICYHOLDERS Pursuant to Texas Labor Code 411.066, The Hartford is required to notify its policyholders that accident prevention services are available from The Hartford at no additional charge. These services may include surveys, recommendations, training programs, consultations, analyses of accident ... | 2 |
Page 1 of 1 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 065-43-7240 IDAHO 910317113 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 013-52-0618-31 KRAUS USA, INC. Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuneration Remuneration Ann... | 1 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number E.E. BISS HEATING & COOLING INC. 1144 MAPLE DRIVE Policy Number FREDERICKSBURG PA 17026 Symbol: RWC Number: C58581872 Policy Period Effective Date of Endorsement 04-17-2020 TO 12-01-2020 04-17-2020 Issued By (Name of Insurance Compan... | 2 |
Schedule Of Covered Autos You Own (Cont'd) Coverages - Premiums, Limits And Deductibles (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding Item Two column applies instead.) Coverages Limit Premium Covered Autos Liability $ 1,000,000 $ Personal Injur... | 2 |
4. liability for any consequence, whether of America necessarily incurred as a direct direct or indirect, of war, invasion, act of result of bodily injury. Foreign enemy, hostilities (whether war be Our reimbursement shall be limited as follows: declared or not), civil war, rebellion, revolution, insurrection or milita... | 2 |
Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company BAS (18) 58 48 91 09 Mutual. Policy Period: INSURANCE From 01/18/2018 To 11/30/2018 Common Policy Declarations 12:01 am Standard Time at Insured Mailing Location Named Insured & Mailing Address Agent Mailing Address & Phone No. TOTAL MALL M... | 2 |
Coverage Is Provided In: Policy Number: Liberty Ohio Security Insurance Company BAS (19) 56 61 27 35 Mutual. Policy Period: INSURANCE From 02/01/2018 To 02/01/2019 Common Policy Declarations 12:01 am Standard Time at Insured Mailing Location Named Insured & Mailing Address Agent Mailing Address & Phone No. SWEETBRIAR S... | 2 |
OLD REPUBLIC INSURANCE COMPANY FORMS INDEX FORMS MADE A PART OF THIS POLICY AT TIME OF ISSUANCE: Form Number Description J-01 (01/16) BUSINESS AUTO INSURANCE POLICY JACKET CA DEC GN 0003 01 16 BUSINESS AUTO DECLARATIONS ORRM 2008 FORMS INDEX ORRM 2009 SCHEDULE OF NAMED INSUREDS PCA 071 01 09 COMPOSITE RATE ENDORSEMENT ... | 0 |
Page 1 of 1 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 065-43-7240 MONTANA 910317113 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 013-52-0618-31 KRAUS USA, INC. Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuneration Remuneration A... | 1 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 EXTENSION OF INFORMATION PAGE Name and Address of Insured: Policy No.: RWR943531802 POCH STAFFING, INC. DBA TRILLIUM STAFFING SOLUTIONS AND SUBSIDIARIES NO FIXED ADDRESS Policy Period: SALT LAKE CITY, UT 84101 July 1, 2013 to July ... | 1 |
Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number UNION COUNTY CONSTRUCTION GROUP, INC. 638 CHERRY STREET Policy Number GLOUCESTER CITY NJ 08030 Symbol: RWC Number: C58582542 Policy Period Effective Date of Endorsement 04-29-2020 TO 12-01-2020 04-29-2020 Issued By (Name of Insurance... | 2 |
POLICY NUMBER: CL00169642 PIL 10 10 08 18 CO 10 10 12 07 SCHEDULE OF FORMS AND ENDORSEMENTS Insured Name: CHILDREN'S HOUR MONTESSORI, LLC Form(s) and Endorsement(s) made a part of this policy at time of issue: Forms Applicable - MULTIPLE LINES OF BUSINESS PIL 20 10 08 18 MINIMUM AND DEPOSIT ENDORSEMENT PIL 01 52 08 18 ... | 0 |
AIG AIG Insurance 877-To-Serve (867-3783) Email: toserve@AIG.com 05/08/2015 AMBER ANDERSON AON RISK INSURANCE SERVICES WEST, INC. 851 SW 6TH AVENUE, SUITE 385 PACIFIC CENTER BUILDING PORTLAND, OR 97204-1309 Re: INSURED NAME: STERLING GOLD MINING CORP Policy No.: CA 363-24-28 Effective Date: 04/12/2015 Dear AMBER ANDERS... | 2 |
MM 99 35 04 11 exceed the cost of renewing or continuing such policy for a period of two years after the "accident." Also, our payment will not operate to reduce the benefits otherwise payable under this coverage. F. Definitions The following definitions are added for Personal Injury Protection Coverage: 1. "Occupying"... | 2 |
PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date f... | 2 |
Schedule of Forms and Endorsements ace group NAMED INSURED POLICY NUMBER POLICY PERIOD Dillard's Inc. XOO G27373938 1/28/2014 - 1/28/2015 Endorsement Form Number - Title Number Edition Date XS-9U57b (08/09) Schedule of Underlying Insurance XS-20835 (08/06) Commercial Umbrella Liability Policy ALL-20887 (10/06) ACE Prod... | 0 |
Page 1 of 2 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 034-15-7226 SOUTH CAROLINA 917854726 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 082-02-0414-00 TRADESMEN INTERNATIONAL, INC Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuner... | 1 |
CHUBB Name of Insured Attached to and Forming Part of TORTOISE CAPITAL ADVISORS, LLC Policy Number (14)7174-28-82 FEIN 223875939 Policy Period 09/27/13 to 09/27/14 Location of Operations NO SPECIFIC Effective Date 09/27/13 LOCATION NY Producer Name Name of Company LOCKTON COMPANIES, LLC CHUBB INDEMNITY INSURANCE COMPAN... | 1 |
IFG Policy Number: 959B001177 Companies COMMERCIAL GENERAL LIABILITY DECLARATIONS Named Insured: Effective Date: ABRON TRUCKING, LLC 07/24/2018 Item 1. LIMITS OF INSURANCE $ 1,000,000 General Aggregate Limit (Other Than Products - Completed Operations) $ Incl. In Gen. Agg. Products - Completed Operations Aggregate Limi... | 2 |
EXCESS LIABILITY DECLARATIONS Starr Indemnity & Liability Company Dallas, Texas Administrative Office: 399 Park Avenue, 8th Floor, New York, NY 10022 POLICY NUMBER: 1000035092151 RENEWAL OF: 1000035092141 PRODUCER NAME: Lockton Companies ADDRESS: 444 W. 47th St., Suite 900 Kansas City, MO 64112 ITEM 1. NAMED INSURED: I... | 2 |
Liability Policy - 8842740 - for Express Services of Canada Inc. 13 5.5.2 Advertising Advertising means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purposes of attracting customers or supporters. For the purposes of this defini... | 2 |
ENDORSEMENT NO. 5 CONTINUED Marsh, Inc. (Reputational Risk & Crisis Management Group) 1166 Avenue of the Tracy Knippenburg Gillis (877) 246-2774 Public Relations, Crisis Americas Managing Consultant Management services. New York, NY (212) 345-3886 Direct 10036 (516) 661-0308 Cell (516) 536-5845 Other Serving clients in... | 2 |
THIS FORM APPLIES IN: TX COMMERCIAL AUTO CA 99 03 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO MEDICAL PAYMENTS COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to cover... | 2 |
Policy Number AS2-641-437443-064 ITEM THREE - SCHEDULE FOR COMPOSITE STATE SUMMARY State Exposure Premium IL 18.00 $12,996 IN 1.00 $722 NE 5.00 $3,610 ACS 99 02 08 12 © 2012 Liberty Mutual Insurance. All rights reserved Page 1 of 1 | 2 |
Endorsement No.: 10 Effective Date: December 01, 2020 Issue Date: Attached to and forming part of Policy No.: US00011830L120A Issued To: Burns & McDonnell, Inc. By: XL Insurance America, Inc. Drop Down & Non-Accumulation of Limits Endorsement This endorsement changes the policy. Please read it carefully. This endorseme... | 2 |
THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WorldSource A CAPITAL STOCK COMPANY (HEREIN CALLED THE COMPANY) A MEMBER COMPANY OF AIG, EXECUTIVE OFFICES: 175 WATER STREET, 19TH FLOOR, NEW YORK NY DECLARATIONS FOREIGN COMMERCIAL PACKAGE POLICY Policy No.: Policy Term: Date of Issue: WS11009178 From: September 15, 2... | 2 |
Tata AIG General Insurance Company Ltd. TATA AIG INSURANCE COMMERCIAL GENERAL LIABILITY SCHEDULE Agent/Broker Producer Name:- - J B Boda Insurance Brokers Pvt Ltd Agent/Broker License Code:- DB138/03 Agent/Broker Contact No:- 022-66314949 POLICY NO. - 0301004560 COMPANY NAME AREA PRODUCER NAME AREA NAMED INSURED: Perki... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 TRUCKING--LOCAL HAULING ONLY-- 7228 35,207 6.36 $2,239 ALL EMPLOYEES AND DRIVERS AUTOMOBILE--HAULAWAY OR 7229 2,028 7.53 $153 DRIVEAWAY--LONG DISTANCE HAULING--ALL EMPLOYEES AND DRIVERS TRUCKING--PARCEL OR PACKAGE 7230 3,388 7.38 $... | 1 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 59 (01-05) EXTENSION OF INFORMATION PAGE Schedule of Forms ITEM 3D POLICY NO. (22) 7177-67-12 Form Numbers Applicable States WORKERS COMPENSATION FORMS AND ENDORSEMENTS WC 90 03 84 07-18 CHUBB WC CLAIM KIT CA PN 04 99 08 12-19 CA POLICYHOLDER NOTICE... | 0 |
IL 02 31 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARKANSAS CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PA... | 2 |
SCHEDULE OF COVERED AUTOS YOU OWN (ITEM THREE OF THE DECLARATIONS) (Continued) POLICY NUMBER: 37 UEN KW8365 Absence, if any, of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00044 96 FORD ID NO. 1FDKE30F6THA50368 GARAGED: LOUISVI... | 2 |
II 3005 MS (08 13) APPLICABLE IN LOUISIANA LOUISIANA FRAUD STATEMENT Any person who knowingly presents a fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. APPLICABLE IN MAI... | 2 |
Endorsement No.: 03 Form: CUU 401 0805 Rev. Page: Effective Date: January 1, 2014 Issue Date: Attached to and forming part of Policy No.: US00045338LI14A Issued To: American Automobile Association of Northern California, Nevada & Utah By: XL Insurance America, Inc. Amendment of Cancellation Provisions This endorsement ... | 2 |
A person or organization may sue us to recover on an agreed settlement or on a final judgment against you obtained after trial. We will not be liable for damages that are not payable under the terms of this policy or that are in excess of the applicable limit of this policy. An agreed settlement means a settlement and ... | 2 |
Policy Number AS2-641-433446-140 GARAGEKEEPERS SCHEDULE Applicable to: CA 01 94 10 13, CA 99 37 10 13, CA 99 71 10 11 Location Number Address Where You Conduct Garage Operations 14 3052 W Martin Luther King Blvd, Fayetteville, AR 72701 Coverages Limit Of Insurance And Deductible Premium Comprehensive $60,000 Limit Of I... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 FINISHING OF TOOLS OR DIE MAKING OPERATIONS ELECTRICAL APPARATUS MFG. NOC 3179 1,915,381 1.62 $31,029 ELECTRIC OR GAS LIGHTING 3180 78,391 2.77 $2,171 FIXTURES MFG. HEAT TREATING--METAL 3307 16,229 3.07 $498 WELDING OR CUTTING NOC ... | 1 |
Page 3 of 8 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 024-78-0994 COLORADO 917019479 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 055-09-1016-10 EXPRESS SERVICES, INC. Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuneration Remune... | 1 |
POLICY NUMBER: 37 UEA AA2667 LISTING OF COVERAGE PARTS AND ENDORSEMENTS FORMING A PART OF THE POLICY The following is a listing of policy provisions, forms and endorsements by Form Number and Title that form a part of the policy at issue. FORM NUMBER TITLE 25 IL0261 09-07 KANSAS CHANGES - CANCELLATION AND NONRENEWAL 26... | 0 |
LIQUOR LIABILITY COVERAGE PART - SCHEDULE Insurance for this coverage part provided by: ZURICH AMERICAN INSURANCE COMPANY Prem. Bldg. Class No. No. Exposure Premium Base Code 001 001 58161 $ 75,000 PER 1,000 OF GROSS SALES Class Description: RESTAURANTS, TAVERNS, HOTELS, MOTELS, INCLUDING PACKAGE SALES Rate Premium 1.2... | 1 |
U United Educators withhold or delay), other than a settlement for which no payment for Damages or Defense Costs is sought by the Insureds under this Policy. 9. If the Insured elects not to appeal a judgment in which Damages and Defense Costs are in excess of the Deductible, if applicable, we may appeal at our own cost... | 2 |
Z R Extended Schedule of Underlying Insurance ZURICH Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add'l Prem. Return Prem. AUC 0179037-05 06/15/2020 06/15/2021 06/15/2020 28832000 Named Insured and Mailing Address: Producer: MAX MANDELL MUNICIPAL GOLF COURSE LOCKTON COMPANIES, LLC 27700 FM ... | 2 |
4. The Each Occurrence Limit of Insurance shown in the Declarations continues to apply. However, instead of being subject to the Aggregate Limit of Insurance shown in the Declarations, such limit will be subject to the applicable Designated Construction Project Aggregate Limit. B. This insurance only applies in excess ... | 2 |
PAGE 3 POLICYWRITING INDEX ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE 1006340000 GLO 0144516-01 GLO 0144516-00 02-27-2018 02-27-2019 CG 20 10 04-13 ADDL INSD - OWNERS/LESSEES/CONTRACTORS CG 20 26 04-13 ADDL INSD-DESIGNATED PERSON/ORGANIZATION CG 21 06 05-14 EXCL-ACC/DISCL OF CO... | 0 |
Liberty Mutuál. IRONSHORE™ Railroad General Liability INSURANCE A Liberty Mutual Company LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company, hereinafter the "Company") 175 Berkeley Street, Boston, MA 02116 Toll-Free number: 1-800-677-9163 Policy Number: Broker Name and Address Renewal of 1st... | 2 |
(5) "Waste" means any waste material: (a) Containing "byproduct material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content; and (b) Resulting from the operation by any person or organization of any "nuc... | 2 |
SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 37 WB BN3284 Schedule Number: 01-26-01 Effective Date: 10/01/13 Effective hour i... | 1 |
AAIS This endorsement changes CU 0705 09 10 the policy Page 1 of 1 -- PLEASE READ THIS CAREFULLY -- EXCLUSION -- EXTERIOR INSULATION AND FINISH SYSTEMS COVERAGES E AND U The Commercial Excess/Umbrella Liability "We" do not pay for: Coverage is amended as follows. All other "terms" of the policy apply, except as amended... | 2 |
Policy Number 41WCI0840304 SCHEDULE OF FORMS AND ENDORSEMENTS ARCH INSURANCE COMPANY Named Insured HALL MECHANICAL CONTRACTORS, Effective Date: 10-26-2020 12:01 A.M., Standard Time Agent Name WILLIS TOWERS WATSON MIDWEST, INC. Agent No. 00267 WORKERS COMPENSATION FORMS AND ENDORSEMENTS 00 ML0042 44 12-19 IMPORTANT NOTI... | 0 |
POLICY NUMBER: FBCAT0256502 COMMERCIAL AUTO ARCH INSURANCE COMPANY MOTOR CARRIER DECLARATIONS ITEM ONE PRODUCER: FREBERG ENVIRONMENTAL INSURANCE, INC NAMED INSURED: M LAKE 23, LLC DBA: ABSOLUTE RECYCLING MAILING ADDRESS: 201 W. 11TH AVE NORTH KANSAS CITY, MO 64116 POLICY PERIOD: From 06-03-2015 to 06-03-2016 at 12:01 A... | 2 |
(2) the amount of the covered claim, subject to (3) the applicable Limits of Insurance and any sublimits of insurance. Notwithstanding the foregoing, no person or entity shall be a Named Insured if trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited ... | 2 |
Premium Summary (continued) TOTAL $ 3,090 Renewal 13/14 If ATD coverage is provided on this policy, additional certificate and handling fees may be imposed during the policy term. Coverage Premium Additional certificate and handling fees may be imposed as respects to certification of pressure equipment as mandated by S... | 2 |
ITEM FOUR Schedule Of Hired Or Borrowed Covered Auto Coverage And Premiums (Cont'd) Cost Of Hire Rating Basis For Mobile Or Farm Equipment - Physical Damage Coverages Estimated Annual Cost Of Hire For Each State (Excluding Autos Hired With A Driver) Premiu Premium Mobile Farm Mobile Farm Coverages State Limit Of Insura... | 2 |
"Source material", "special nuclear material", and (c) Any equipment or device used for the process- "by-product material" have the meanings given ing, fabricating or alloying of "special nuclear them in the Atomic Energy Act of 1954 or in any material" if at any time the total amount of such law amendatory thereof. ma... | 2 |
IMPORTANT NOTICE Effective July 1, 1978 The Georgia Workers' Compensation Law requires that compensation payments to injured workers begin within fourteen days after the employer has knowledge of the accident. If a delay is due to your failure to report a claim to the company the penalty will be paid by you. Your Insur... | 2 |
COMMERCIAL GENERAL LIABILITY CG 00 01 12 07 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. b. This insurance applies to "bodily injury" and Read the entire policy carefully to determine rights, "property damage" only if: duties and what is and is not covered. (1) The "bo... | 2 |
XS SU 3003 12 07 HDI GLOBAL INSURANCE COMPANY COMMERCIAL UMBRELLA LIABILITY DECLARATIONS Policy Number: XLD13304-02 EXTENSION SCHEDULE FOR COIM USA, INC. IL SU 4003 12 12 HDI GLOBAL INSURANCE COMPANY POLICY JACKET XS SU 3001 07 14 COMMERCIAL EXCESS LIABILITY DECLARATIONS PAGE XS SU 3002 12 07 COMMERCIAL EXCESS LIABILIT... | 0 |
NATIONWIDE MUTUAL INSURANCE COMPANY Nationwide Certificate of Insurance Common Declarations This Certificate of Insurance is issued to the Enrolled Member of the Sports, Leisure and Entertainment Risk Purchasing Group. In return for the payment of premium we agree to provide the Enrolled Member insurance, subject to al... | 2 |
STARR Workers Compensation and Employers Liability Insurance Policy Policy Number: 100 0003868 INDEMNITY Named Insured: HOSPITAL COURIERS, LLC A MEMBER OF STARR COMPANIES Agent: CLAUDIA MANDATO 0502726 ENDORSEMENT SCHEDULE State Form Nbr. Ed. Date Description US WC000000C 1/15 WC & EL POLICY CA WC000404 4/84 PENDING RA... | 0 |
Policy Number GLO 6555467-04 ENDORSEMENT ZURICH AMERICAN INSURANCE COMPANY Named Insured FIRSTSERVICE CORPORATION Effective Date: 10-25-13 12:01 A.M., Standard Time Agent Name LOCKTON COMPANIES LLC Agent No. 37385-000 DESIGNATED ENTITY EXCLUSION THIS INSURANCE DOES NOT APPLY TO "BODILY INJURY", "PROPERTY DAMAGE" OR "PE... | 2 |
POLICY NUMBER: XSL G27855702 Texas Notice - ace group Information and Complaints AVISO IMPORTANTE IMPORTANT NOTICE Para obtener información o para presentar una queja: To obtain information or make a complaint: Usted puede llamar al número de teléfono gratuito de la You may call the Company's toll-free telephone number... | 2 |
Page 1 of 1 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 067-71-2693 NEW HAMPSHIRE 910520598 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 082-14-0714-10 THE DAY & ZIMMERMANN GROUP INC Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remune... | 1 |
Z ZURICH COMMON POLICY DECLARATIONS Policy Number BAP 9670773-05 Renewal of Number BAP 9670773-04 Named Insured and Mailing Address Producer and Mailing Address THE PERKINS + WILL GROUP, LTD LOCKTON COMPANIES LLC (SEE NAMED INSURED ENDT) 444 W 47TH ST STE 900 185 BERRY ST LOBBY 1 KANSAS CITY MO 64112-1906 STE 5100 SAN ... | 2 |
COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS ADJ. NO. NAMED INSURED EFFECTIVE DATE POLICY NUMBER Time & Alarm Systems Inc 05/31/2020 51GL008096-201 FORM OF BUSINESS: Individual Joint Venture Limited Liability Company Partnership Trust Organization including a corporation (but not including a Partnership, Joi... | 2 |
Liberty Insurance Corporation Item 3. Coverage D - Extension of Information Page Miscellaneous Form and Endorsement Schedule Continued: Policy Endorsements Comments Form Number Form Name WC 00 03 13 Waiver of Our Right to Recover From Others Endorsement WC 00 04 01 A Aircraft Premium Endorsement WC 00 04 14 Notificatio... | 0 |
Page 1 of 1 EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 066-45-5273 GEORGIA 913142063 Policy Prefix & No. Schedule INTRA/Independent State Risk ID 026-75-0713-00 PERGAN MARSHALL, LLC Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuneration Remunerat... | 1 |
ITEM THREE Schedule Of Hired Or Borrowed Covered Auto Coverage And Premiums (Cont'd) Cost Of Hire Rating Basis For Mobile Or Farm Equipment - Other Than Physical Damage Coverages Estimated Annual Cost Of Hire For Each State Premium Coverages State Mobile Equipment Farm Equipment Mobile Equipment Farm Equipment Covered ... | 2 |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Longshore and Harbor Workers' Compensation Act Coverage Endorsement Policy Number: 37 WBR QU2574 Endorsement Number: 4 Effective Date: 06/01/2016 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: THE WEIT... | 2 |
NOTICE TO POLICYHOLDERS Access to Your Information Our employees, employees of our affiliated companies, and third party service providers will have access to information we collect about you and your business as is necessary to effect transactions with you. We may also disclose information about you to the following c... | 2 |
362201500005400010 Form Number/Edition Date Title LC 29 08 10 11 Advertisement Redefined LC 04 02 10 11 Professional Health Care Services by Employees or Volunteer Workers Coverage LC 24 27 10 13 Non-Owned Watercraft Amendment With Limitation of Coverage LC 25 19 01 15 Designated Construction Project or Designated Loca... | 0 |
ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Designated Location(s) Coverage The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: THIS POLICY DOES Any liability you may have for any injury to any ... | 2 |
IMPORTANT NOTICE TO OUR POLICYHOLDERS THANK YOU FOR RENEWING YOUR POLICY WITH THE HARTFORD. WITH THIS NOTICE WE ARE PROVIDING YOU ONLY WITH THE DECLARATIONS PAGE, WHICH OUTLINES YOUR COVERAGES, AND WITH THOSE POLICY FORMS, NOTICES, AND BROCHURES WHICH ARE DIFFERENT FROM THOSE WHICH WE PROVIDED WITH YOUR PREVIOUS POLICY... | 2 |
POLICY NUMBER: GLO 5833581-06 COMMERCIAL GENERAL LIABILITY CG 03 00 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEDUCTIBLE LIABILITYINSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVE... | 2 |
COMMERCIAL LIABILITY - Liberty UMBRELLA DECLARATIONS Mutuál. INSURANCE Issued by: Liberty Insurance Corporation Policy Number: TH7-681-041343-861 Producer: LOCKTON COMPANIES LLC Renewal of: TH7-681-041343-860 444 W 47TH ST STE 900 KANSAS CITY, MO 64112-1906 Item 1. Named Insured and Mailing Address: CARROLS RESTAURANT ... | 2 |
IL 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY C... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 PIANO--MFG. 2923 65,115 1.87 $1,218 IRON OR STEEL--FABRICATION-- 3030 26,347 4.41 $1,162 IRONWORKS OR STEELWORKS-- SHOP--STRUCTURAL AND DRIVERS SHEET METAL PRODUCTS MFG. 3076 1,104,260 2.24 $24,735 TOOL MFG.--NOT DROP OR 3113 96 1.... | 1 |
1. Bodily Injury by Accident. The limit shown for "bodily injury by accident-each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by... | 2 |
BUSINESS AUTO COVERAGE FORM DECLARATIONS Policy Number (06) 7498-55-64 ITEM ONE Named Insured Agent Name MILBANK MANUFACTURING CO LOCKTON COMPANIES, INC Effective Date: 09-01-2006 12:01 A.M., Standard Time Agent No. 35773-999 ITEM TWO - SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages w... | 2 |
FORMS SCHEDULE EFFECTIVE DATE: 09/01/2017 NAMED INSURED: AMTECOL, INC. AMERICAN HI-TECH PETROLEUM & CHEMICALS, INC. U.S. AUTOMOTIVE, INC. POLICY NO: CA 441-66-06 CA0001 (0310) BUSINESS AUTO COVERAGE FORM CAO143 (0507) CALIFORNIA CHANGES CAO424 (0406) CALIFORNIA AUTO MED PAY COV CA2048 (0299) DESIGNATED INSURED CA2154 (... | 0 |
Schedule Designated Workers' Employees State of Employment Compensation Law All employees not All states except CA, State of hire subject to the Workers HI, NJ, WI & WY Compensation Law Issued by Liberty Mutual Fire Insurance Company16586 For attachment to Policy No.WA2-C2D-095587-652 Effective Date Premium $ Issued to... | 2 |
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A Edition 1/08 EXTENSION OF INFORMATION PAGE Name and Address of Insured: Policy No: RWR9435384-02 Towne Holdings, Inc. 1201 Market Street Policy Period: 01-01-2015 To 01-01-2016 Philadelphia, PA 19107 NAICS#: 812930 FEIN: 770685277 # Of Employee... | 1 |
Liability Policy - 8842740 - for Express Services of Canada Inc. 2 1.9 Period of Insurance Inception: 01. October 2015 Expiration: 01. October 2016 At 12:01 a.m. Standard Time at the address of the First Named Insured 1.10 Premium $ 29,888 Flat Premium $ 29,888 Minimum Premium (Retained) 1.11 Broker's Name and BFL Cana... | 2 |
IL N 106 09 03 VIRGINIA FRAUD STATEMENT It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the pur- pose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. IL N 106 09 03 © ISO Properties, Inc., 2003 Page 1 of 1 | 2 |
The payroll of all executive officers of a e. The payroll of clerical office employees; corporation and individual insureds or co- partners engaged principally in clerical Clerical office employees are those operations or as salespersons, and officers employees who work in an area which is and co-partners who are inact... | 2 |
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