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PROOF OF INSURANCE (2010) CLOSEDR 11 ACORD. CERTIFICATE OF LIABILITY INSURANCE CHI ID -17 DATE (MMlDD1HRI 09/04/0 9 PRODUCER United Agencies, Inc. (R) CA License #0252636 301 E. Colorado Blvd. Ste. 200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER DATE MM /DDlYY Pasadena CA 91101 Phone: 626- 449 -0301 Fax:626- 564 -6565 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A -. Interstate Fire & Casualty Ins 350 Main Street INSURER B: Christian Brothers Mechanical INSURER C PREMISES (Eaoccurence) Services, Inc. dba: Process Cooling 11140 Thurston Lane Mira Loma CA 91752 INSURER D. X INSURER E SGL1001812 \.0 V M r%M%j GQ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM /DDlYY DATE (MM /DD/YY LIMITS City of El Segundo GENERAL LIABILITY 350 Main Street E1 Segundo CA 90245 EACH OCCURRENCE $ 1,000,000 PREMISES (Eaoccurence) $ 50,000 A X X COMMERCIAL GENERAL LIABILITY SGL1001812 04/24/09 04/24/10 VIED EXP (Any one person) $ 5,000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER.. PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. 1,000,000 POLICY X IT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED'AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGG $ ANY AUTO $ EXCESWUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE - $ RETENTION $ WORKERS COMPENSATION AND Ulm TORY LIMITS ER E . EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? E L DISEASE - EA EMPLOYE $ E DISEASE - POLICY LIMIT 1 $ If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Subject to all policy terms, exclusions and conditions. RE: Eire Station #2, 2161 E, El Segundo Blvd., E1 Segundo, Ca. 90245; City of El Segundo, its officers, officials, employees and volunteers are named as an Additional Insured per the attached General Liability CG 2010 1185 endorsement if required by written contract. Primary Wording ICB 8001 04/05 ** SEE ATTACH v.It t :c1Mt _Fl 1 Y 1 [UN t.Gf\ I Ir IVl9 � V CITYOFE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 10* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of El Segundo 350 Main Street E1 Segundo CA 90245 AU I D PRESE TATIV ACORD 25 (2001108) 11_� © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25 (2001 ** endorsement attached. No Professional Liability for Architect or Engineering Provided on the General Liability Insurance see attached Certificate of Insurance evidencing Professional Liability. THIS CERTIFICATE OF INSURANCE CANCELS AND SUPERSEDES CERTIFICATE ISSUED 08/24/09. *PLEASE NOTE COPYRIGHT LAWS APPLY TO THE ACORD FORM PROHIBITING US FROM CROSSING OFF THE "ENDEAVOR TO CLAUSE" HOWEVER, PER UNITED AGENCIES, INC. PROCEDURES WILL NOTIFY YOU WITHIN 30 DAYS IF THE POLICY CANCELS. POLICY NUMBER: SGL1001812 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of El Segundo, its officers, officials, employees and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) Is amended to include as an Insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE: Fire Station #1, 314 Main Street, El Segundo, Ca. 90245; CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ POLICY NUMBER: SGL1001812 AMENDMENT OF OTHER INSURANCE CONDITION - PRIMARY INSURANCE FOR AUTOMATIC STATUS ADDITIONAL INSURED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART K required under a written "insured contract" with you, paragraph a. Primary Insurance In SECTION IN — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Irnsurance is amended by adding the following paragraph: Not withstanding the foregoing, the insurance afforded to any person or organization who has been added to this policy by an Automatic Status Additional insured Endorsement is primary and non - contributory Insurance, but only as respects 'bodily Injur or "property damage" liability arising out of 'your work" performed after the effective date of this policy under a written contract between you and such person or organization that requires you to maintain primary and non - contributory insurance and to Include such person or organization as an additional insured thereunder. RE: Fire Station #2, 2161 E, El Segundo Blvd., El Segundo, Ca. 90245; All other terms and conditions of this policy remain unchanged. ICS- 8001 04 -05 DATE (MMIDDIYYYY) ACORC� CERTIFICATE OF LIABILITY INSURANCE 09/24/2009 PRODUCER 909.792.234S FAX 909.792.0159 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Beall Financial &Insurance Svcs, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 130 W. Vine Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Redlands, CA 92373 INSURERS AFFORDING COVERAGE NAIC # INSURED CHRISTIAN BROTHERS MECHANICAL SERVICE, INC. INSURERA: GENERAL INSURANCE CO OF AMERIC 24732 & PROCESS COOLING INSURER B: 11140 THURSTON LANE INSURER C: MIRA LOMA, CA 91752 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR INS TYPE TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY POLICY NUMBER P LI Y EFF DATE MMIDD 1 DATE MWDO LIMITS EACH OCCURRENCE $ BE TO RENTED PREMISES Ea occurren ce $ MED EXP (Any one person) S AUTHORIZED REPRESENTATIVE 350 MAIN STREET CLAIMS MADE F7 OCCUR EL SEGUNDO, CA 90245 RICHARD BEALL PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE LOC AUTOMOBILE LIABILITY 24CC26700100 04/24/2009 04/24/2010 COMBINED SINGLE LIMIT (Ee accident) $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ A SCHEDULEDAUTOS HIRED AUTOS BODILY INJURY (Per accident) S X X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO H AUTO ONLY - EA ACCIDENT S -'- OTHER THAN EA ACC AUTO ONLY: AGG - $ $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE S S DEDUCTIBLE RETENTION E S WORKERS COMPENSATION TORY LIMITS ER E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY ANY pROPRIETOR/PARTNER/EXECUTIVEa E.L. DISEASE - EA EMPLOYEE $ OFFICERWEMBER EXCLUDED? (Mandatory in NH) 11 yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS E: FIRE STATION 01, 314 MAIN STREET, EL SEGUNDO, CA 90245; FIRE STATION #2, 2161 E. EL SEGUNDO BLVD, L SEGUNDO, CA 90245. HE CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED TO THE AUTO LIABILITY PER ENDORSEMENT CA 71 10 03 07 ATTACHED. 0 DAY NOTICE OF CANCELLATION NON-PAYMENT PREMIUM wT� REP UED - -- CERTIFICATE HVL.UtK " ^'•- °—"'-" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL *)61ft MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, NXMX XINA iLXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX CITY OF EL SEGUNDO AUTHORIZED REPRESENTATIVE 350 MAIN STREET EL SEGUNDO, CA 90245 RICHARD BEALL .nee onnn Af`nOn f`nlDOnPATlnld All rinhts razarved. AGVKU zD (cuva/uT) - - --- - - -- - - The ORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25 ACORD CHR ,. CERTIFICATE OF LIABILITY INSURANCE 11 DATE(MM/DD/ - HRI -17 09/04/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION United Agencies, Inc. (R) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United License cies, 36 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 301 E. Colorado Blvd. Ste. 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone: 626- 449 -0301 Fax:626- 564 -6565 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. Houston Casualty Company Christian Brothers Mechanical INSURER B. Services, Inc . INSURER C. dba: Process Cooling 11140 Thurston Lane INSURER D. Mira Loma CA 91752 INSURER E COVEKAUhb 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE GENERAL LIABILITY POLICY NUMBER DATE MM /DDIYY) DATE MM /DD/YY LIMITS EACH OCCURRENCE $ PREMISES (Ea occurence) - $ n arnRn rnRPe)ROTInN 19f COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS MADE F� OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GENL AGGREGATE LIMIT APPLIES PER PRO LOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY -. AGG $ $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER E . EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ EL DISEASE - POLICY LIMIT $ It yes, describe under SPECIAL PROVISIONS below OTHER A Professional Liab HCO95128301 05/01/09 05/01/10 Prof Liab $1,000,000 Ded. $15,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Subject to all policy terms, exclusions and conditions. RE: Fire Station #2, 2161 E, El Segundo Blvd., El Segundo, Ca. 90245; THIS CERTIFICATE OF INSURANCE CANCELS AND SUPERSEDES CERTIFICATE ISSUED 08/24/09. *PLEASE NOTE COPYRIGHT LAWS APPLY TO THE ACORD FORM PROHIBITING US FROM CROSSING OFF THE "ENDEAVOR TO CLAUSE" HOWEVER, PER UNITED AGENCIES, INC. ** SEE ATTACHMENT cEKIIrIC.AItMULUCR CITYOFE —...- - - - - -- - -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MO MMOWN MAIL 10* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of El Segundo 350 Main Street 11111111w El Segundo CA 90245 AU I D PRE�TATIV n arnRn rnRPe)ROTInN 19f AGUKU 20 (ZU` IUtfJ v 18 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. HR ACMA CERTIFICATE OF LIABILITY INSURANCE C 11 DATE(MM1DDlHRI -17 09/04/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Uaited Agencies, Inc. (R) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United License cies , 36 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 301 E Colorado Blvd. Ste. 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pasadena CA 91101 Phone:626- 449 -0301 Fax:626- 564 -6565 Christian Brothers Mechanical Services, Inc. dba: Process Cooling 11140 Thurston Lane Mira Loma CA 91752 INSURERS AFFORDING COVERAGE I NAIC # INSURER A'. Insurance Company of the West INSURER B'. INSURER C. INSURER D- INSURER E UUVtrcHkPts 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY ='FFFCTTVF-- DATE MM /DD/YY) DATE MM /DD/YY LIMITS El Segundo CA 90245 AU I D PRESE TATIV rn Arncn r nI20e1RATl(1N 1QI GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE $ Ht:114 I= PREMISES (Ea occurence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER PRO- LOC POLICY JECT ] AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGG $ $ EXCESS /UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WSD2162946 -02 04/24/09 04/24/10 X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $1,000,000 E L DISEASE - POLICY LIMIT 1 $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Subject to all policy terms, exclusions and conditions. RE: Fire Station #2, 2161 E, E1 Segundo Blvd., El Segundo, Ca. 90245; THIS CERTIFICATE OF INSURANCE CANCELS AND SUPERSEDES CERTIFICATE ISSUED 08/24/09. *PLEASE NOTE COPYRIGHT LAWS APPLY TO THE ACORD FORM PROHIBITING US FROM CROSSING OFF THE "ENDEAVOR TO CLAUSE" HOWEVER, PER UNITED AGENCIES, INC. ** SEE ATTACHMENT l.tK1II'II.NICi1VLUGR CITYOFE - -- - - - -- -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 110/INO1l111111111111liMAIL 10* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of El Segundo 350 Main Street El Segundo CA 90245 AU I D PRESE TATIV rn Arncn r nI20e1RATl(1N 1QI ACORU 20 (1UU11Uts) 18 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. D 25 (20011081