DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 04/01/2020
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).
PRODUCER CONTACT
NAME: Progressive Advantage Business Program
Progressive Advantage Business Program PHONE FAX
PO Box 5316 (A/C, No, Ext): 844-306-4926 (A/C, No):
Binghamton, NY 13902 E-MAIL
ADDRESS:
[email protected] INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Midvale Indemnity Company 27138
INSURED INSURER B :
ELLE RYER DBA CLEANING BY ELLE INSURER C :
5629 N 78TH WAY INSURER D :
SCOTTSDALE AZ 85250 INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 179656502066415 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
A CLAIMS-MADE X OCCUR N N GLP1071980 04/02/2020 04/02/2021 PREMISES (Ea occurrence) $100,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO- PRODUCTS - COMP/OP AGG $2,000,000
X POLICY
JECT
LOC
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea accident)
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY
AUTOS ONLY AUTOS (Per accident)
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 Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECU
-TIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT
N/A
(Mandatory in NH) E.L. DISEASE - EA
EMPLOYEE
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT
PROFESSIONAL LIABILITY OCCURRENCE
AGGREGATE
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Janitorial Cleaning Services
CERTIFICATE HOLDER CANCELLATION
ELLE RYER DBA CLEANING BY ELLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
