                           CERTIFICATE OF INSURANCE              DATE __________

PRODUCER:                                THIS CERTIFICATE IS ISSUED AS A MATTER
 _____________________________________   OF INFORMATION ONLY AND CONFERS NO
 _____________________________________   RIGHTS UPON THE CERTIFICATE HOLDER.
 _____________________________________   THIS CERTIFICATE DOES NOT AMEND,
 _____________________________________   EXTEND OR ALTER THE COVERAGE AFFORDED
CODE: __________   SUBCODE: __________   BY THE POLICES BELOW.
                                             COMPANIES AFFORDING COVERAGE
INSURED:                                 CO LETTER A ___________________________
 _____________________________________   CO LETTER B ___________________________
 _____________________________________   CO LETTER C ___________________________
 _____________________________________   CO LETTER D ___________________________
 _____________________________________   CO LETTER E ___________________________
COVERAGES
CO                           POLICY    POLICY   POLICY
LTR TYPE OF INSURANCE        NUMBER   EFF DATE EXP DATE              LIMITS
 _ GENERAL LIABILITY       __________ ________ ________ GEN AGGREGATE $ ________
   _ COMM GEN LIABILITY    __________ ________ ________ PROD COMP/OPS $ ________
   _ CLAIMS MADE _ OCCUR   __________ ________ ________ PERS & AD INJ $ ________
   _ OWNERS & CONTRS PROT  __________ ________ ________ EACH OCC      $ ________
   _ ____________________  __________ ________ ________ FIRE DAMAGE   $ ________
   _ ____________________  __________ ________ ________ MED EXPENSE   $ ________
 _ AUTOMOBILE LIABILITY    __________ ________ ________ COMB LIMIT    $ ________
   _ ANY AUTO              __________ ________ ________ BOD INJ/PER   $ ________
   _ ALL OWNED AUTOS       __________ ________ ________ BOD INJ/ACC   $ ________
   _ SCHEDULED AUTOS       __________ ________ ________ PROP DAMAGE   $ ________
   _ HIRED AUTOS           __________ ________ ________ MED PAYMENTS  $ ________
   _ NON-OWNED AUTOS       __________ ________ ________ PERS INJURY   $ ________
   _ GARAGE LIABILITY      __________ ________ ________ UNINS MOTOR   $ ________
   _ ____________________  __________ ________ ________ _____________ $ ________
 _ EXCESS LIABILITY        __________ ________ ________ EACH OCC      $ ________
   _ UMBRELLA FORM         __________ ________ ________ AGGREGATE     $ ________
   _ OTHER THAN UMBRELLA   __________ ________ ________ SELF-INS RET  $ ________
 _ WORKERS COMPENSATION    __________ ________ ________ _ STAT LIMIT
          AND              __________ ________ ________ EACH ACC      $ ________
       EMPLOYERS           __________ ________ ________ DIS POL LIMIT $ ________
       LIABILITY           __________ ________ ________ DIS EACH EMPL $ ________
 _ OTHER
   ______________________  __________ ________ ________ ________________________
   ______________________  __________ ________ ________ ________________________
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS _____________________
 _______________________________________________________________________________
 _______________________________________________________________________________
CERTIFICATE HOLDER                  CANCELLATION
 __________________________________ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
 __________________________________ BE CANCELLED BEFORE THE EXPIRATION DATE
 __________________________________ THEREOF, THE ISSUING COMPANY WILL ENDEAVOR
 __________________________________ TO MAIL ___ DAYS NOTICE TO THE CERTIFICATE
 __________________________________ HOLDER NAMED TO THE LEFT, BUT FAILURE TO
 __________________________________ MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
 __________________________________ OR LIABILITY OF ANY KIND UPON THE COMPANY,
 __________________________________ ITS AGENTS OR REPRESENTATIVES.
 _ ADDITIONAL INSURED               AUTHORIZED REPRESENTATIVE
