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MIRRO-1 OP ID: JH

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

03/17/2017

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 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 Adam Heal
NAME:
Query Insurance Agency, Inc.
330 May Mart Drive PHONE Ext): 815-562-4152 FAX No): 815-562-2126
Rochelle, IL 61068 (A/C, No, (A/C,
Adam Heal
E-MAIL adam@queryinsurance.com
ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : Cincinnati Insurance Company 10677
INSURER B : CNA Surety
INSURED Mirror Landscapes, Inc
Jason Hemmer INSURER C :
1431 Chicago Ave INSURER D :
Dixon, IL 61021

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.

INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY)

A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
$ 100,000
CLAIMS-MADE X OCCUR ENP 0014764 03/06/2017 03/06/2018 DAMAGE TO RENTED
PREMISES (Ea occurrence)

MED EXP (Any one person) $ 10,000

PERSONAL & ADV INJURY $ 1,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
2,000,000
POLICY PRO- LOC PRODUCTS - COMP/OP AGG $
JECT

OTHER: $
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
A ANY AUTO ENP 0014764
03/06/2017 03/06/2018 BODILY INJURY (Per person)
ALL OWNED
AUTOS X SCHEDULED BODILY INJURY (Per accident) $
AUTOS
X HIRED AUTOS
X NON-OWNED PROPERTY DAMAGE $
AUTOS (Per accident)

$

UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
$
WORKERS COMPENSATION X PER OTH-
STATUTE ER
A AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE EWC0289017 01/01/2017 01/01/2018 E.L. EACH ACCIDENT 500,000
N/A 62196047 500,000
OFFICER/MEMBER EXCLUDED? 500,000

(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 45,000

If yes, describe under E.L. DISEASE - POLICY LIMIT $

DESCRIPTION OF OPERATIONS below 10/21/2016 10/21/2017 Limit

B Tri City Bond

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER MIRRORL CANCELLATION

Mirror Landscapes Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1431 Chicago Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Dixon, IL 61020 ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD