FORTORA-01
SHOOK
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
1/8/2025
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).
CONTACT NAME:
PRODUCER
Scalzo, Zogby, & Wittig, Inc. 120 Lomond Ct Utica, NY 13502
PHONE
FAX
(315) 792-0000
(315) 792-4637
(A/C, No, Ext): E-MAIL ADDRESS:
(A/C, No):
info@szwinsurance.com
INSURER(S) AFFORDING COVERAGE
NAIC #
Utica Specialty Risk Insurance Company Utica National Ins Co of Texas Utica National Ins of Ohio Arch Ins. Co.
43451 43478 13998 11150
INSURER A :
INSURED
INSURER B :
Fort Orange Claim Service Inc. PO Box 447 Clifton Park, NY 12065
INSURER C :
INSURER D :
INSURER E : INSURER F :
COVERAGES
CERTIFICATE NUMBER:
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.
POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY)
INSR LTR
ADDL SUBR INSD WVD
TYPE OF INSURANCE
POLICY NUMBER
LIMITS
1,000,000
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person)
$
50,000 10,000
X
5683504
1/1/2025 1/1/2026
CLAIMS-MADE
OCCUR
$
$ PERSONAL & ADV INJURY $
1,000,000 2,000,000 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
X
PRO- JECT
POLICY
LOC
PRODUCTS - COMP/OP AGG
$
OTHER:
$
1,000,000
B
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
$
(Ea accident)
X
5684626
1/1/2025 1/1/2026
ANY AUTO
BODILY INJURY (Per person) $
OWNED
SCHEDULED
AUTOS ONLY
AUTOS
BODILY INJURY (Per accident) $
PROPERTY DAMAGE (Per accident)
HIRED
NON-OWNED AUTOS ONLY
$
AUTOS ONLY
$
5,000,000
C
X
OCCUR
UMBRELLA LIAB EXCESS LIAB
EACH OCCURRENCE
$
5684631
1/1/2025 1/1/2026
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
$
B
PER
OTH-
X
WORKERS COMPENSATION AND EMPLOYERS' LIABILITY
STATUTE
ER
Y / N
5684636
1/1/2025 1/1/2026
500,000 500,000 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?
E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ $
N / A
If yes, describe under (Mandatory in NH)
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT per occurence/aggreg
$
D Cyber Liability
C-4LPY-014596-CYBER-2024 1/2/2025
1/2/2026
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Proof of coverage
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
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