auxilio mutuo póliza 2016

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)764-0063cia@colonialpr.com

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