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LOWE'S - WORKMANS COMP & GENERAL LIABILITY_v1SHOULD 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-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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 AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED 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 EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR 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 PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY B FL LIC 3,000,000 04/01/2024 TB2651294595073 ATL-004938248-11 2,000,000 04/01/2024 5,000,000 WC5651294595023 (WI, MN) X 22829 5,000,000 (WC per statute)EW265N294595033 (AOS) N X04/01/2023 0 04/01/2024 04/01/2023 04/01/2024 Lisa.beam@marsh.com AS2651294595103 Excess Workers' Compensation C 3,000,000 3,000,000 33600 Interstate Fire & Casualty Co 2,000,000 X C X 03/17/2023 3,000,000 04/01/2023 3,000,000 RE: Lowe's Home Centers, LLC installation for customer: Lowe's Home Centers, LLC is a Named Insured under the captioned policies. Florida General Contractor's License # CGC1508417, Peter Anthony Cafaro, III, Certified General Contractor. Florida Contractor's License # CCC1326824, Peter Anthony Cafaro, III, Certified Roofing Contractor. X 04/01/2023 Miami Shores Village, FL 33138 Miami Shores Village A 04/01/2023 A LM Insurance Corporation CN102776519-Lowes-Front-23-24 (WC per statute) 04/01/2024 5,000,000 USZ000210200 Excess Workers' Compensation C 3,000,000 23035 3,000,000 2,000,000 04/01/2024 WA565D294595013 (AOS) 100 North Tryon Street, Suite 3600 Marsh USA Inc. X Charlotte, NC 28202 and subsidiaries Lowe's Companies, Inc. Mooresville, NC 28117 1000 Lowe's Boulevard X EW565N294595063 (FL) 04/01/2023 10050 NE 2 Ave. 04/01/2023 A Lisa Beam 04/01/2024 1-704-374-8365 Liberty Mutual Fire Insurance Company ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Limit (Per Statute): $3,000,000� � � 22 EXCESS WORKERS COMPENSATION (MA)� � Charlotte Effective/Expiration dates: 04/01/2023 - 04/01/2024� Policy Number: EW265N294595053 � � Limit (Per Statute): $3,000,000� �� �� Carrier: Liberty Mutual Fire Insurance Co.� EXCESS WORKERS COMPENSATION (MO) � Certificate of Liability Insurance CN102776519 Carrier: Liberty Mutual Fire Insurance Co. � Effective/Expiration dates: 04/01/2023 - 04/01/2024� � The Automobile Liability policy evidenced above is subject to additional self-insured retentions excess of limits shown for various perils covered.�� Workers' Compensation and Excess Workers' Compensation policies include a self-insured retention of $2,000,000.� Marsh USA Inc.� and subsidiaries� Lowe's Companies, Inc.� Mooresville, NC 28117 1000 Lowe's Boulevard� 25 Policy Number: EW265N294595043�