HomeMy WebLinkAbout583422 CLEAR RISK INC - CONTRACT - AGREEMENT MISC - CLEAR RISK INC (2)AUTHORIZED REPRESENTATIVE
c 2010, Centre for Study of Insurance Operations. All rights reserved.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder and imposes no liability on the insurer.
CERTIFICATE OF LIABILITY INSURANCE
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OR OCCURRENCE
POSTAL
CODE
BROKER CLIENT ID:
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 requirements, terms
or conditions 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 terms, exclusions and conditions of such policies.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSURANCE COMPANY
AND POLICY NUMBER
EFFECTIVE
DATE
EXPIRY
DATE
LIMITS OF LIABILITY
(Canadian dollars unless indicated otherwise)
PRODUCTS AND / OR COMPLETED OPERATIONS
EMPLOYER’S LIABILITY
CROSS LIABILITY
TENANTS LEGAL LIABILITY
NON-OWNED AUTOMOBILES
HIRED AUTOMOBILES
AUTOMOBILE LIABILITY
DESCRIBED AUTOMOBILES
ALL OWNED AUTOMOBILES
LEASED AUTOMOBILES **
** ALL AUTOMOBILES LEASED IN EXCESS OF
30 DAYS WHERE THE INSURED IS REQUIRED
TO PROVIDE INSURANCE
EXCESS LIABILITY
UMBRELLA FORM
OTHER LIABILITY (SPECIFY)
BODILY INJURY AND PROPERTY
DAMAGE COMBINED
BODILY INJURY (PER PERSON)
BODILY INJURY (PER ACCIDENT)
PROPERTY DAMAGE
Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail ________ days written notice to the certificate
holder named above, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives.
AUTHORIZED REPRESENTATIVE
ISSUER
DATE
EACH OCCURRENCE
AGGREGATE
This certificate does not amend, extend or alter the coverage afforded by the policies below.
POLLUTION LIABILITY EXTENSION
NON OWNED AUTOMOBILE
POSTAL
CODE
POSTAL
CODE
1. CERTIFICATE HOLDER - NAME AND MAILING ADDRESS 2. INSURED’S FULL NAME AND MAILING ADDRESS
3. DESCRIPTION OF OPERATIONS/LOCATIONS/AUTOMOBILES/SPECIAL ITEMS TO WHICH THIS CERTIFICATE APPLIES (but only with respect to the operations of the Named Insured)
4. COVERAGES
5. CANCELLATION
6. BROKERAGE/AGENCY FULL NAME AND MAILING ADDRESS ADDITIONAL INSURED NAME AND MAILING ADDRESS
(but only with respect to the operations of the Named Insured)
8. CERTIFICATE AUTHORIZATION
COMMERCIAL GENERAL LIABILITY
- GENERAL AGGREGATE
PERSONAL AND ADVERTISING INJURY
LIABILITY
MEDICAL PAYMENTS
TENANTS LEGAL LIABILITY
PRODUCTS AND COMPLETED OPERATIONS
AGGREGATE
- EACH OCCURRENCE
DED. AMOUNT OF
COVERAGE INSURANCE
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY
YYYY/MM/DD YYYY/MM/DD
POSTAL
CODE
PERSONAL INJURY LIABILITY
OR
POLLUTION LIABILITY EXTENSION
7.
CONTACT NUMBER(S)
TYPE
TYPE
NO.
NO.
TYPE
TYPE
NO.
NO.
SIGNATURE OF EMAIL ADDRESS
CSIO - Certificate of Liability Insurance CA4301e 201009