auxilio mutuo póliza 2016
DESCRIPTION
poliza auxilio mutuoTRANSCRIPT
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?
ADDL SUBRINSRLTR INSD WVD
DATE (MM/DD/YYYY)
CONTACTPRODUCERNAME:
FAXPHONE(A/C, No):(A/C, No, Ext):
E-MAILADDRESS:
INSURER A :
INSURED INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE $
DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT
$OTHER:COMBINED SINGLE LIMIT $(Ea accident)
BODILY INJURY (Per person) $ANY AUTO
ALL OW NED SCHEDULED BODILY INJURY (Per accident) $AUTOS AUTOS
NON-OW NED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS
$
EACH OCCURRENCE $OCCUR
CLAIMS-MADE AGGREGATE $
$DED RETENTION $
PER OTH-STATUTE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
CERTIFICATE OF LIABILITY INSURANCE
Policy Number:
AND /OR ET ALS PO BOX 21345SAN JUAN, PR 00928-1345
Colonial Insurance Agency
1101 Munoz Rivera Ave
San Juan PR 00925
(787)754-7150
Date Entered:
(787)[email protected]
Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977
SISTEMA UNIVERSITARIO ANA G. MENDEZ
9/2/2015
A
CPP-28200096 08/31/2015 08/31/2016
1,000,000.
1,000,000.
1,000,000.
1,000,000.
1,000,000.
10,000.
AUL-20821515 08/31/2015 08/31/2016
20,000,000.
A CPP-28200096 08/31/2015 08/31/20161,000,000.
1,000,000.
1,000,000.
Sistema Universitario Ana G. Méndez certified that all students registered at Univrsidad del Este:
Aguadilla, Bayamón, Jayuya, Comerío; Universidad del Turabo: Gurabo, Yabucoa, Ponce, Isabela, Cayey
HOSPITAL AUXILIO MUTUO
PO BOX 191227
SAN JUAN PR 00919-1227
MARITZA VAZQUEZ
10,000
and Barceloneta are cover under the policies above stated.CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED
9/2/2015
REAL LEGACY
ADMIRAL INSURANCE COMPANY
Carolina, Barceloneta, Cabo Rojo, Yauco, Arecibo, Santa Isabel; Universidad Metropolitana: Cupey,
B MEDICAL PROFESSIONALLIABILITY
EO-000026628-02 08/31/2015 08/31/2016 $1,000,000.
$3,000,000.
EACH CLAIM
AGGREGATE