2019/10/01 West, a Thomson Reuters Business Certicate of Liability Insurance DocuSign Envelope ID:OBE2AE6A-408B-47F5-8D31-E4C4A11BCE21
MID
ACX>RV CERTIFICATE OF LIABILITY INSURANCE DA0012019DIYYYY)
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 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 CONTACT
Marsh USA,Inc.o
1166 Avenue of the Americaso (A/C,No,Ext): No,.(AIC,
NewYork,NY 10036ro E-MAIL
Attn:NewYorkCerts@marsh.com Fax:212-345-3695
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:ACE American Insurance Company 22667
INSURED West,a Thomson Reuters Businesso INSURER B:ACE Prol)erty and Casualty Insurance Company 20699
610Opperman Driveo INSURER C:Indemnity Insurance Company of North America 43575
Eagan,MN 55123 INSURER D:ACE Fire Underwriters Insurance Company 20702
INSURER E
INSURER F,,
COVERAGES CERTIFICATE NUMBER: NYC-010743051-03 REVISION NUMBER: 6
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED 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.
INSR POLICY MW
LTR TYPEOFINSURANCE A DLSUBR POLICY NUMBER MMlOOIYYYYY MMD .
LIMITS
A X COMMERCIAL GENERAL LIABILITY HDOG71445562 10/01/2019 10/01/2020 EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE I X I OCCUR PREMISES CEa occurrence $ 500,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
G'EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY U JECT U LOC PRODUCTS-COMP/OP AGG $ 2,000,000
A AUTOMOBILE LIABILITY ISAH2529415A 10/01/2019 10/01/2020 $ 3,000,000
X1ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULE BODILY INJURY(Per accident) $
AUTOS ONLY D AUTOS
HIRED NON-OWNED $
AUTOS ONLY AUTOS ONLY Par aotidam
X UMBRELLA LAB X OCCUR G27963675004 10/01/2019 10/01/2020 EACH OCCURRENCE $ 5,000,000
EXCESSLIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED RETENTION$ $
C WORKERS COMPENSATION WLR C66039316(AO ) 1101=9 1070172020 X EF2 TH-
D ANDEMPLOYERS'LIABILITY YIN SCFC66039353 WI 10/01/2019 10/01/2020 TA7 TE .
ANYPROPRIETOR/PARTNER/EXECUTIVE ( ) 1,000,000
A OFFICE RIM EMBER EXCLUDED? NIA E.L.EACHACCIDENT $
(Mandatory in NH) WLR C66039274(AZ,CA,MA) 10/01/2019 10/01/2020 E.L DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONSI LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space a required)
CERTIFICATE HOLDER CANCELLATION
West,aThomson Reuters Businesso SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
6100pperman Dr.o THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Eagan,MN 55123 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Michaela Grasshoff
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD