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COI Example

This document is a Certificate of Liability Insurance issued on 11/16/2022 for Precision Appliance Installation Inc. It outlines the insurance coverage provided, including general liability and workers' compensation, along with the limits of each policy. The Westford Condominium is listed as an additional insured party under the general liability policy.

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0% found this document useful (0 votes)
39 views1 page

COI Example

This document is a Certificate of Liability Insurance issued on 11/16/2022 for Precision Appliance Installation Inc. It outlines the insurance coverage provided, including general liability and workers' compensation, along with the limits of each policy. The Westford Condominium is listed as an additional insured party under the general liability policy.

Uploaded by

biancafair72
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 11/16/2022


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).
CONTACT
PRODUCER
NAME: TYLER TRAN
PHONE
(A/C, No, Ext): (714) 248-9944 FAX
(A/C, No): (714) 248-9945
C N D INSURANCE AGENCY
E-MAIL
ADDRESS: TYLER@CNDINSURANCEAGENCY.COM
7032 HAZARD STREET STE 6 INSURER(S) AFFORDING COVERAGE NAIC #
WESTMINSTER CA 92683 INSURER A : AMCO INSURANCE COMPANY 19100
INSURED INSURER B :

INSURER C :
PRECISION APPLIANCE INSTALLATION INC INSURER D :
12612 HOOVER ST INSURER E :
STANTON CA 90680-1261 INSURER F :
COVERAGES CERTIFICATE NUMBER: 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
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 300,000
MED EXP (Any one person) $ 5,000
A X ACP BPS 3110107264 04/13/2022 04/13/2023 PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
A OFFICER/MEMBER EXCLUDED? N N/A ACP WC 3029486761 11/03/2022 11/03/2023
(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

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

The Westford Condominium - 10750 Wilshire Blvd. #1001 Los Angeles, CA 90024 is included as an additional
insured on General Liability policy per the attached endorsement, if required.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE


THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.

The Westford Condominium AUTHORIZED REPRESENTATIVE


10750 Wilshire Blvd.
Los Angeles, CA 90024

© 1988-2015 ACORD CORPORATION. All rights reserved.


ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

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