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kEQUIRED COVERAGES - Where "X" Appears in Box CERTIFICATES OF INSURANCE <br /> <br />× 1. <br /> <br />Workers' Compensation <br />a. Statutory Compensation coverage. <br />b. Employer's liability insurance <br /> with limit not less than $100,000 <br /> per occurrence. <br /> <br />Insurance Company(s) <br /> <br />Policy Number(s),Policy Period <br /> (dates) <br /> <br />Signature of Individual author- <br />ized by Insurance Company to <br />bind Company to coverage shown, <br />and above endorsement require- <br />ments. <br /> <br />Name <br /> <br />Address <br /> <br />City, State, Zip <br /> <br />X 2. Comprehensive General Liability <br /> <br />a. Minimum Limits of Liability: <br /> ~ $1,000,000 per occurrence <br /> <br />be <br />X <br />X <br />X <br /> <br />combined single limit bodily <br />injury and property damage. <br /> <br />coverages: <br />Bodily Injury <br />Property Damage <br />Blanket Contractual <br />Personal Injury <br />Products/Completed Operations <br />Broad Form Property Damage <br />Fire Damage Legal Liability <br /> <br />c. Deductible not to exceed <br /> $5,000 per occurrence <br />d.X Cross Liability or Severability <br /> of Interests Clause in policy <br /> <br />Insurance Company(s) <br /> <br />Policy Number(s), Policy Period <br /> (dates) <br /> <br />Signature of Individual author- <br />ized by Insurance Company to <br />bind Company to coverage shown, <br />and above endorsement require- <br />ments. <br /> <br />Name <br /> <br />Address <br /> <br />City, State, Zip <br /> <br />e. Occurrence Form Claims Made Form <br /> <br /> <br />