Page 92 - 1.Table Of Contents.indd

P. 92

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
6/8/2017
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 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
NAME:
Alliant Insurance Services, Inc. PHONE FAX
333 Earle Ovington Blvd. (A/C, No, Ext): (A/C, No):
E-MAIL
Uniondale NY 11553 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :Travelers Property Casualty Co of A 25674
INSURED INSURER B :Travelers Indemnity Company 25658
Barr & Barr, Inc. INSURER C :Charter Oak Fire Insurance Company 25615
460 West 34th Street INSURER D :Indian Harbor Insurance Company 36940
10th Floor
New York NY 10001 INSURER E :Tokio Marine America Insurance Comp 10945
INSURER F : American Guarantee and Liability In 26247
COVERAGES CERTIFICATE NUMBER: 1796730495 REVISION NUMBER:
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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY VTRJ-CO-2381A784-TIL-17 4/1/2017 4/1/2018 EACH OCCURRENCE $2,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $300,000
X Contractual Liab MED EXP (Any one person) $15,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY X PRO- LOC PRODUCTS - COMP/OP AGG $4,000,000
JECT
OTHER: $
B AUTOMOBILE LIABILITY VTK-CAP-2381A796-IND-17 4/1/2017 4/1/2018 COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
(Per accident)
AUTOS
$
A X UMBRELLA LIAB X OCCUR VTSMJ-CUP-4E994578-TIL-17 4/1/2017 4/1/2018 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION $$10,000 $
C WORKERS COMPENSATION VTRO-UB-2381A772-17 4/1/2017 4/1/2018 X PER OTH-
AND EMPLOYERS' LIABILITY Y / N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
D Protective,Pollution,Professional CEO7446636 4/1/2017 4/1/2018 $5,000,000/10,000,000 Occ / Agg
E Leased/Rented Equipment CPP6408887-02 4/1/2017 4/1/2018 $100,000 Limit
F Excess Liability AEC 0191657-01 4/1/2017 4/1/2018 $20,000,000 Occ / Agg
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: METWEST THREE 4050 BOY SCOUT BLVD,. TAMPA, FL 33607
Evidence of Insurance

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MetLife Real Estate THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
4010 Boy Scout Boulevard, Suite 160 ACCORDANCE WITH THE POLICY PROVISIONS.
Tampa, FL 33611
AUTHORIZED REPRESENTATIVE

87 88 89 90 91 92 93 94 95 96 97