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ISSUE DATE (M~/DD/YYY¥): <br /> <br />)LTR) <br /> <br />m <br /> <br />! <br />,m <br /> <br />ll4IS CERTIFICATE IS I~SllEI) AS A MAI'FER 11r I~TI~ IN_Y ~ ~RS ND <br />RIBHTS ~ ~ CERTIFICATE HDLDER. THIS CERTIFICATE DOLES NDT MEND, <br />EXTEND OR II. IBt l}E Cl)~rr. RflSE AFFORDED ~Y THE POLICIES lr:J.DW, <br /> <br />COMP(INIE$ AFFORI) INB COVERABE <br /> <br /> C: <br /> <br /> £: <br /> <br />LETTER <br /> <br />LEI'TER <br />LEI'FER <br />[_KI'ER <br /> <br />I I <br /> <br />J~J . <br /> A IGE'IE)~ LIAIIlLITY <br /> r £xx:a,m~I~ ~ LIABILIIY <br /> I <br /> I [ ]clai~ ~de <br /> <br /> I[ IDk~ERS & CONTffiCTORS PROTECTIVE <br /> ) <br /> I[] <br /> ) <br /> III <br /> I <br /> <br />IEFI:ECT. ~TEI f~TI~ ~TE <br />J~/DD/YYYY ~/DD/YYYY <br /> <br />60-031 977 <br /> <br />G0--031 977 <br /> <br />10/19/199~ <br /> <br />10/19/!991 <br /> <br />10/19/1991 <br /> <br />10/191199~ <br /> <br />I AUID~DBII.E LIABILITY <br /> <br /> HIRED <br /> NON.-O(a~]) AUI'DS <br /> BARD~E LIABIUTY <br /> <br />} <br />I <br />} <br /> <br />I PffiIXIC~/~S <br />I flG6RE~TE <br />I~. & ADUERTISINB <br />I INJURY <br />I <br />lEACH Drl]JRRENCE <br />IFIRE DAMAGE (~rf DNE <br />I FI~) <br />IME~ICAJ. EXPENSE <br />I DNE PERSDN) <br />I <br />ICD~I~ SIN~I.E LIMIT <br />I~DILY INJURY <br />I (PER PERSDN) <br />IBODILY INJURY <br />I (PER ~IDF. ffB <br /> <br />lPRDPER~ <br />I <br /> <br />I <br /> <br />I STIITUTDRY <br /> $ <br /> $ <br /> $ <br /> <br />S <br /> <br />s 1~000 <br />$ 1,000 <br />$ 1~000 <br />$ 50 <br />$ 5 <br /> <br />500 <br /> <br />AGG~GATE <br />$ <br /> <br />(~ ~II)EhFr) <br />{DISUSE ,-PDLICY LIMIT) <br />(DISEASE-EACH EMPLOY. I <br /> <br />mD~R <br /> <br />m <br />m <br />m <br /> <br />}I>-~RIDTIDltS DF DAERiqTI~I~TIDNSIVEHICLE$1RESTRICTIDNS/SPECIPL ITEP~ <br />; ~II ~NI~L S~ELTER, <br /> <br />~= ~IFICATE HOLiF~R --' '.~ ' "-~ CP21CElJ_ATI~ <br /> <br /> 1 <br />CI~ DF ~ ) <br /> <br />mPJ)~s (3/~) <br /> <br />Shq]Ui.D ~ DF ~ ~ DESC, RIBED DDLICIES BE ~)m BEFORE THE <br />EXPIRATION DATE ~ ~ ISStlINB CaMPP~NY WILL ENDEAVDR TD ~IL <br /> I0 ~YS WRITTEN NOlI~ TD THE CERTIFICATE HOLDER NAMED TD THE <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIBATIDN OR LIt~BIC- <br />ITY DF ~ KIND UPON THE COMFA:~F, ITS AGENTS DR ~ATIVEB. <br /> <br />I ~R[IE]) ~hTI~ <br /> <br /> ~ ACDRD is a registered traoe~erk of ACI]RI) Corporation <br /> <br />m <br /> <br /> <br />