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

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).

CONTACT PRODUCER NAME:

PHONE FAX

(A/C, No, Ext): (A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

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

GENERAL LIABILITY EACH OCCURRENCE $

DAMAGE TO RENTED

COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $

CLAIMS-MADE OCCUR MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $

PRO- POLICY LOC $ JECT

COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $

ANY AUTO BODILY INJURY (Per person) $

ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS

NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident)

$

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

WORKERS COMPENSATION WC STATU- OTHTORY LIMITS ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A

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

If yes, describe under

DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $

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

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

© 1988-2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

NORTB-2 OP ID: H1

10/08/15

Phone: 602-956-4220 PACKAGE CHOICE TEAM

Hill & Usher LLC

Insurance. Bonds. Benefits.

3033 North 44th Street, #300

Phoenix, AZ 85018

Package Choice Ins Program

Fax: 602-956-4418 866-977-4725 877-956-4418

packagechoice@hillusher.com

Seneca Insurance Company 10936

North Brooklyn Productions LLC

279 Starr Street

Brooklyn, NY 11237-2609

1,000,000

A X SGL4600342 07/14/15 07/14/16 100,000

X 5,000

Excluded

2,000,000

1,000,000

X

RE: THIS DOCUMENT IS FOR REFERENCE ONLY. THE INSURED PROCURED INSURANCE 

COVERAGE AT THE LIMITS INDICATED HEREIN THAT WAS IN-FORCE ON THE DATE THIS 

CERTIFICATE WAS ISSUED. IN ORDER TO VERIFY CURRENT IN-FORCE COVERAGE, 

REQUEST AN UP-TO-DATE CERTIFICATE OF LIABILITY INSURANCE BE ISSUED TO A 

SPECIFIC CERTIFICATE HOLDER.

PROOF-1

NORTH BROOKLYN

PRODUCTIONS, LLC

279 STARR ST

BROOKLYN, NY 11237