Security Service Agreement – 1/2024 Page 1 BKP.: _________ Client: _________
BLACK KNIGHT PATROL
Security Services Agreement
505 South Pacific Avenue. Suite 201. Phone: 213-985-6499 San Pedro, CA 90731
[email protected] PPO No. 121005
This Professional Services Agreement (hereinafter the “Agreement”) is entered into between Black Knight Patrol Inc., a California Corporation, (hereinafter “BKP”) and City of Redondo Beach Police Department, whose billing address is 401 Diamond Street. Redondo Beach, CA 90277 (hereinafter “Client”) on August 5th, 2025. BKP and Client shall hereinafter collectively be referred to as “the parties” and each as the “party.” The parties agree as follows:
1. SERVICES.
(a) BKP and Client hereby agree that BKP shall furnish
the number of specified armed security personnel and/or patrols (as applicable) at the location(s) (hereinafter “Premises”), and on the day(s) and time(s) specified in Exhibit “A” attached hereto.
(b) Security personnel services shall be provided in
accordance with this Agreement and may include written
instructions or orders (hereinafter referred to as the “Post Orders”) to be mutually agreed upon between the parties.
Should any conflict arise between the terms of any other document and this Agreement, this Agreement shall
control. In the absence of Post Orders, BKP shall
provide security services in accordance with accepted
security industry standards, and in accordance with all State and local requirements. BKP’s primary
responsibility will be to observe and report to Client.
2. PAYMENTS. [STANDING GUARDS ONLY]:
(a) BKP shall invoice Client for services rendered every week (or at such other time as mutually agreed in writing between the parties).
(b) Invoices are due and payable upon receipt and
become delinquent sixty (60) days after receipt.
(c) Service Rates: It is agreed that the compensation due BKP under this Agreement shall include charges at the
Service Rates specified in Exhibit “B,” including rates for Holidays and overtime.
(d) Client agrees to pay all invoices in the full amount without offset of any kind or nature unless there is a good faith dispute concerning the rate or quantity of charges, in which event Client agrees to pay the undisputed
amount and to notify BKP as to the reason for the dispute and the value thereof.
3. PAYMENTS. [PATROL CLIENTS ONLY]:
(a) BKP shall invoice Client for services in advance,
prior to the start of patrol services, and receipt of
payment is required for patrol services to commence and, in the case of continuing service, to continue.
(b) Invoices shall be sent every month, prior to the start of the month and are due and payable upon receipt. BKP
is under no obligation to continue Patrol Services if
Client fails to provide payment in full prior to the
commencement of the Patrol Services for the upcoming
month. In the event additional hours or services are
rendered, Client shall be invoiced at the end of that
month for such additional services and/or costs.
Payment of those additional fees and costs are due upon receipt and become delinquent ten (10) days after
receipt.
(c) Service Rates: It is agreed that the compensation due BKP under this Agreement shall include charges at the
Service Rates specified in Exhibit “B,” including rates for Holidays and overtime.
(d) Client agrees to pay all invoices in the full amount without offset of any kind or nature unless there is a good faith dispute concerning the rate or quantity of charges, in which event Client agrees to pay the undisputed
amount and to notify BKP as to the reason for the dispute and the value thereof.
(e) In the case of unpaid invoices that are delinquent, or for invoices not paid in full within the time stated in subparagraph (b) above, then Client shall pay BKP a late charge of one and one-half percent (1.5%) per month on
such overdue amount, including prior late charges, until paid in full. Late charges will not be applied to unpaid amounts disputed by the Client in good faith.
4. INDEPENDENT CONTRACTOR/EMPLOYER.
(a) BKP agrees to perform the services described in this Agreement as an independent contractor and not as an
employee, agent, joint venturer, affiliate, or associate of Client.
(b) BKP shall hire all security personnel and shall be
responsible for the payment of all wages, appropriate
expenses, and customary taxes and insurance.
(c) All security personnelshall be under the direction and control of BKP. BKP shall have the right to assign such security personnel as it sees fit. BKP may change
security personnel in its sole and absolute discretion.
Security Service Agreement – 1. 2024 Page 2 BKP: _________ Client: _________
Upon reasonable request by Client, BKP shall reassign
its employees if such request does not violate any
applicable state or federal law as determined by BKP.
(d) BKP shall provide its security personnel with all
necessary uniforms, badges and equipment (as
appropriate). Non-standard uniforms or equipment
required by Client will be provided as agreed upon and
at a cost as mutually agreed upon in writing.
(e) All security personnel shall be employees of BKP or subcontractors to BKP (when appropriate) and shall not
be deemed to be employees of Client.
5. PROPERTY.
(a) All property, equipment and supplies furnished by
BKP to provide the services hereunder shall remain the
property of BKP and BKP shall always, during and after
the term of this Agreement, have the sole right to install, maintain and remove such property, equipment and
supplies.
(b) All Client-owned equipment and supplies provided
to BKP to aid in providing the services hereunder will be given proper care by BKP and returned to Client on
demand in original condition, normal wear and tear
excepted.
6. CLIENT VEHICLES. If Client requires BKP
personnel to use any vehicle or operate any equipment
during the course of security personnel duties, other than the security personnel's own personal vehicle or a
vehicle provided by BKP, Client agrees to maintain
comprehensive fire, theft, collision, and liability
insurance on such vehicles, that BKP and its personnel
will be deemed an insured, and that the insurance
covering such vehicles is primary and non-contributory.
7. LOSS OF KEYS. If Client entrusts BKP with keys
to its Premises, facilities or equipment, BKP will be
responsible for such keys only when they are in the
custody of a BKP employee. Should keys be lost by
other than theft while in the custody of BKP, BKP agrees to replace all such keys and related locks at the cost of replacement, including labor, not to exceed one thousand dollars ($1,000.00) as a sole remedy to Client.
8. INDEMNIFICATION.
(a) BKP shall defend, indemnify, and hold harmless
Client and its employees under this Agreement,
controlling said defense, against any claim, loss, or
damages. In the event of a claim based on injury
sustained by Client’s employee, BKP shall only have to
defend, indemnify, and hold harmless Client in an
amount no greater than any damages or disability
payments awarded by a worker’s compensation
administrative law judge or the benefits the employee
may be entitled to under California’s workers
compensation law.
(b) BKP’s indemnity obligations herein shall not be
construed as a waiver of the statutory protections
afforded to BKP by all applicable Workers'
Compensation laws or statutes.
(c) The indemnity obligations of BKP and Client set
forth herein shall survive the expiration or termination of this Agreement.
9. INSURANCE.
(a) At all times during the term of this Agreement, BKP will maintain in full force and effect without
interruption, the following insurance policies: (i)
Workers’ Compensation insurance for BKP employees
for the statutory limits; and (ii) Commercial general
liability insurance with a single limit of not less than one million dollars ($1,000,000.00) per occurrence.
(b) Client agrees to assume all risks of loss, or damage to its Premises, business, and property and to property of others on Client’s Premises occurring as result of fire, theft or other casualty or loss and Client waives all rights of recovery, indemnification or subrogation against BKP or BKP’s insurer for any such loss or damage, however
caused.
(c) Client shall provide and maintain at its cost a
commercial general liability insurance with a single limit of not less than one million dollars ($1,000,000.00) per occurrence. This policy shall remain in full force and
effect for the period of the services provided by BKP.
BKP shall be added as an additional insured on the policy and Client shall provide an additional insured
endorsement evidencing that BKP is an additional
insured, and coverage is in effect during the full or
extended term of this Agreement.
(d) In the event of a loss or damage to the Premises,
facilities or equipment of Client, or facilities or
equipment of others on the Premises, due to fire or other casualty, Client’s insurance shall be primary to any
insurance provided by BKP.
(e) Client shall give written Notice to BKP of any or
potential Claims of Client arising out of or relating to this Agreement within thirty (30) days following notification of the occurrence giving rise to such Claims or potential Claim. No action to recover any Claim of Client shall be instituted or maintained against BKP by Client unless
notice of such Claim shall have been given by Client to BKP in the manner and form set forth herein. No action
to recover for any Claim of Client shall be instituted or maintained by Client against BKP unless said action
shall have been instituted not later than twelve (12)
months following notification of the occurrence giving
rise to such Claim.
10. NO WARRANTY. Client recognizes that BKP is
not an insurer of property or persons and makes no
warranty, express or implied, that the security services provided will prevent loss, damage or injury to Client, Client’s guests, invitees, employees or property or from the injury or death of any person whomsoever or the
consequences therefrom.
Security Service Agreement – 1. 2024 Page 3 BKP: _________ Client: _________
11. TERMINATION. This Agreement may be
terminated at any time by either party following the
initial term, without cause, by giving thirty (30) days written Notice to the other party. In the event of a
material breach of any term or provision of this
Agreement by either party including, but not limited to, the timely payment by Client to BKP of all invoiced
charges, this Agreement may be terminated immediately
without penalty to the non-breaching party.
12. NO THIRD-PARTY RIGHTS. Nothing in this
Agreement is intended to confer any rights or remedies
on anyone other than the parties to the Agreement and
their respective successors, representatives and assigns.
The provisions of this Agreement shall not entitle any
person not a signatory to this Agreement to any rights as a third-party beneficiary, or otherwise, it being the
specific intention of the parties hereto to preclude any and all-non-signatory parties from any such third-party beneficiary rights, or any other rights whatsoever.
13. WAIVER. The failure of any party at any time or
times to require performance of any provision hereof
shall in no manner affect the right later to enforce the same. No waiver by any party of any condition, or of the breach of any term, agreement, covenant, representation or warranty contained in this Agreement, whether by
conduct of otherwise, in any one or more instances, shall be deemed to be or construed as a further or continuing waiver of any such condition or of the breach of any
other term, agreement, covenant, representation or
warranty of this Agreement.
14. INVALIDITY OF PROVISIONS. The invalidity
of all or any part of any provision of this Agreement shall not render invalid the remainder of such provision or any other provision of this Agreement.
15. ENTIRE AGREEMENT. This Agreement and its
Exhibitsset forth the entire agreement and understanding of the parties in respect of the transactions contemplated hereby and supersedes all prior and contemporaneous
negotiations, promises, covenants, agreements,
representations, arrangements, undertakings and
understandings relating to the subject matter hereof. No representation, promise, inducement or statement of
intention has been made which is not embodied in this
Agreement. None of the parties shall be bound by or
liable for any alleged representation, promise,
inducement or statement not set forth herein.
16. REPRESENTATIVE CAPACITY. Each
signatory to this Agreement in a representative capacity represents and warrants they are authorized to execute
the Agreement on behalf of the person or entity on whose behalf their signature is affixed.
17. CALIFORNIA LAW. This Agreement is entered
into in the State of California. It shall be governed by, interpreted, and construed and enforced in accordance
with the domestic laws of the State of California without reference to principles of conflicts law.
18. INTERPRETATION OF AGREEMENT. The
language of this Agreement shall in all cases be
interpreted as a whole, according to its fair meaning, and not strictly for or against any of the parties, regardless of which is the drafter of this Agreement.
19. BINDING NATURE OF PROVISIONS. All the
terms, agreements, covenants, representations,
warranties and conditions of this Agreement shall be
binding upon and inure to the benefit of and be
enforceable by, the parties hereto and their respective successors and assigns, if any.
20. AMENDMENT/MODIFICATION.
This Agreement and any Exhibits may only be amended,
modified, superseded or canceled in writing executed by each of the parties.
21. FORUM. The parties hereby consent to the
jurisdiction and venue of the courts, federal or state, located in the jurisdiction where the security services are rendered, but in all cases, within the State of California, with respect to any action or suit hereunder.
22. ATTORNEY FEES. In the event any legal action
or proceeding is necessary or appropriate to enforce or construe any provision of this Agreement, or to seek
relief for the breach thereof, the prevailing party in such action or proceeding shall be entitled to recover its
reasonable costs incurred, including reasonable attorney fees.
23. NOTICES. All Notices required from one party to
the other hereunder shall be sent by certified or
registered mail as follows:
Notice to Client shall be sent to:
City of Redondo Beach Police Department
401 Diamond Street. Redondo Beach, CA 90277
Notice to BKP shall be sent to:
Black Knight Patrol Inc.
Attn: Christopher Payne, COO
505 South Pacific Avenue. Suite 201. San Pedro, CA
90731
[email protected]
24. FORCE MAJEURE. The obligations of BKP
hereunder may be suspended during any period where
performance is prevented by acts of God, civil or labor disturbances, pandemic, endemic, or events beyond
BKP’s reasonable economic control.
25. COMPLIANCE WITH LAW.
Security Service Agreement – 1. 2024 Page 4 BKP: _________ Client: _________
(a) BKP shall, at its own cost and expense, comply in full of all applicable federal, state, and local statues, laws, ordinances, rules, regulations, orders, licenses, permits or fees (“Governmental Regulations”) associated with
the services provided under this Agreement.
(b) Client shall, at its own cost and expense, comply in full with all applicable federal, state, and local statues, laws, ordinances, rules regulations, orders, licenses,
permits or fees (“Governmental Regulations”)
applicable to its operations and its performance under
this Agreement, including without limitation: (i)
Environmental Laws; (ii) laws relating to accessibility by and accommodation of handicapped persons; and (iii)
laws relating to discrimination of any type of manner.
26. ASSIGNMENT. Neither Client nor BKP shall
assign this Agreement or assign any rights arising under or to allow the same to be assigned by operation of law or otherwise without the prior written consent of both
parties, which consent shall not be unreasonably
withheld.
THIS AGREEMENT MAY BE EXECUTED IN COUNTERPARTS, USING ELECTRONIC SIGNATURES,
INCLUDING DIGITAL SIGNATURES (SUCH AS DOCUSIGN) AND AN ELECTRONIC OR FACSIMILE COPY AND SIGNATURE PAGE WILL HAVE THE SAME FORCE AND AFFECT AS THE ORIGINAL.
IN WITNESS HEREOF, parties have executed this contract as of the day, month and year indicated above.
Black Knight Patrol Inc. CLIENT: City of Redondo Beach Police Department Sign: Sign:
Name: Name:
Title: Title:
Date: Date:
Chief Operating Officer
7/23/2025 | 1:34 PM PDT
CHRISTOPHER PAYNE
Diane Strickfaden,
Risk Manager
Security Service Agreement – 1. 2024 Page 5 BKP: _________ Client: _________
EXHIBIT “A” FOR SECURITY SERVICES
to Agreement between
Black Knight Patrol Inc.
&
City of Redondo Beach Police Department
LOCATIONS FOR SECURITY SERVICES PROVIDED BY BKP
Location(s) Number of Security
Personnel
Hours
Varies Designated by City of
Redondo Beach on an asneeded basis
Emergency Operating Services- Scheduled and agreed
upon by the “Client” and “BKP” *Accessibility for 2-
hour showtime.
The location(s), day(s) and time(s) listed in this Exhibit “A” may not be altered by Client, unless mutually agreed upon in writing, and signed by the parties. Client acknowledges that Client alone has chosen the number of security personnel and type of services to be provided under the Agreement; that BKP has informed Client that additional security personnel and services are available at an additional cost; and that Client has elected not to avail itself of additional security personnel or services at this time.
SCOPE OF SERVICES PROVIDED:
BKP shall provide uniformed security services at the client’s Location(s) (listed above), or at other additional locations requested by Client and agreed to in writing by BKP. Security officers will, by their presence, serve to act as a deterrent to criminal activity. Security officers will abide by specific Post Orders, if any, mutually agreed upon by the Parties and within the standards of the industry for well-trained security officers. All services will be provided by BKP employees and agents that are highly trained individuals. All such employees shall possess and maintain all required licenses and registrations to perform their duties under this Agreement.
Security Service Agreement – 1. 2024 Page 6 BKP: _________ Client: _________
EXHIBIT “B” FOR SECURITY SERVICES
to Agreement between
Black Knight Patrol Inc.
&
City of Redondo Beach Police Department
BILLING RATES
The billing rates for Security Services (per officer, and/or service) shall be as follows:
REGULAR SERVICE [Armed]: $ 65.00 per hr. (4-hour Minimum) OVERTIME & HOLIDAY: $ 97.50 per hr. (1-hour Minimum)
REGULAR SERVICE [K9]: $ 125.00 per hr. (4-hour Minimum) OVERTIME & HOLIDAY: $ 187.50 per hr. (1-hour Minimum)
The Agreement shall have an initial term of one year, with a maximum annual expenditure not to exceed $15,600.
The parties may, upon mutual written agreement, extend the term of this Agreement under the same or renegotiated terms. “This option clarifies the initial term, uses formal language for the cost limitation, and outlines the extension process.
Regular billing rates shall be used for all regularly scheduled work for the hours specified in Exhibit A for the first 8-hours per Security Officer. All hours more than 8-hours per day or the first 8-hours worked on a 7th consecutive day per Officer shall be paid at the Overtime Rate. All hours more than 12-hours per day per Officer and more than 8-hours per day if the Officer works on a 7th consecutive day shall be paid at Double the Regular Service Rate. Annual Increases: Billing rates shall automatically increase by five percent (5%) per year on each anniversary of this Agreement.
SPECIAL RATES FOR ADDITIONAL SERVICES AND OTHER FACTORS IMPACTING RATES:
1. The holiday billing rate shall be used for all work performed on New Year’s Eve, New Year's Day, Memorial Day,Juneteenth, Independence Day, Labor Day, Veterans Day, Thanksgiving Day, Christmas Eve, and Christmas Day.
05/21/2025
AssuredPartners of California Ins Services, LLC
196 S. Fir Street
P.O. Box 1388
Ventura CA 93002-1388
Sara Burola
(805) 585-6729 (805) 585-6729
[email protected]
Black Knight Patrol, Inc.
517 W. Anaheim St.
Wilmington CA 90744
Summit Specialty Ins Co 16889
Southern Ins Co 19216
Corepointe Insurance Company 10499
25/26 GL/AU/XS/WC
A
ERRORS & OMISSIONS
DEDUCTIBLE: $1,000 SCGL005000040003 05/15/2025 05/15/2026 1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
B ICA1002294 00 05/15/2025 05/15/2026
1,000,000
A SXCS005000034902 05/15/2025 05/15/2026
4,000,000
4,000,000
C CPW1003538 03/08/2025 03/08/2026 1,000,000
1,000,000
1,000,000
Verification of Coverage
U.S. Vets - Wilmington
828 Eubank Avenue
Wilmington CA 90744
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $
$
$
$ PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOS ONLY AUTOS
NON-OWNED
OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH- STATUTEPER
(MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY)
POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB EACH OCCURRENCE $
AGGREGATE $
$
OCCUR
CLAIMS-MADE
DED RETENTION $
PRODUCTS - COMP/OP AGG $
GENERAL AGGREGATE $
PERSONAL & ADV INJURY $
MED EXP (Any one person) $
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
07/24/2025
AssuredPartners of California Ins Services, LLC
196 S. Fir Street
P.O. Box 1388
Ventura CA 93002-1388
Sara Burola
(805) 585-6729 (805) 585-6729
[email protected]
Black Knight Patrol, Inc.
517 W. Anaheim St.
Wilmington CA 90744
Summit Specialty Ins Co 16889
Southern Ins Co 19216
Corepointe Insurance Company 10499
25/26 GL/AU/XS/WC
A
ERRORS & OMISSIONS
DEDUCTIBLE: $1,000 SCGL005000040003 05/15/2025 05/15/2026 1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
B ICA1002294 00 05/15/2025 05/15/2026
1,000,000
A SXCS005000034902 05/15/2025 05/15/2026
4,000,000
4,000,000
C CPW1003538 03/08/2025 03/08/2026 1,000,000
1,000,000
1,000,000
Verification of Coverage
City of Redondo Beach
401 Diamond Street
Redondo Beach CA 90277
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $
$
$
$ PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOS ONLY AUTOS
NON-OWNED
OWNED SCHEDULED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH- STATUTEPER
(MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY)
POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB EACH OCCURRENCE $
AGGREGATE $
$
OCCUR
CLAIMS-MADE
DED RETENTION $
PRODUCTS - COMP/OP AGG $
GENERAL AGGREGATE $
PERSONAL & ADV INJURY $
MED EXP (Any one person) $
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PROJECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY