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Policy Number:

Date Entered: 9/2/2015


DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE

9/2/2015

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).
PRODUCER

CONTACT
NAME:
PHONE
(A/C, No, Ext):
E-MAIL
ADDRESS:

Colonial Insurance Agency


1101 Munoz Rivera Ave
San Juan PR 00925

FAX
(A/C, No):

(787)754-7150
cia@colonialpr.com

(787)764-0063

INSURER(S) AFFORDING COVERAGE

REAL LEGACY
INSURER B : ADMIRAL INSURANCE

NAIC #

INSURER A :
INSURED

SISTEMA UNIVERSITARIO ANA G. MENDEZ


AND /OR ET ALS
PO BOX 21345
SAN JUAN, PR 00928-1345

COMPANY

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. NOTW ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO W HICH 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 SHOW N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR

ADDL SUBR
INSD WVD

TYPE OF INSURANCE

POLICY NUMBER

POLICY EFF
(MM/DD/YYYY)

POLICY EXP
(MM/DD/YYYY)

COM MERCIAL GENERAL LIABILITY


CLAIMS-MADE

OCCUR

CPP-28200096

08/31/2015 08/31/2016

GEN'L AGGREGATE LIMIT APPLIES PER:


PROPOLICY
LOC
JECT

LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

AUTOMOBILE LIABILITY

HIRED AUTOS

1,000,000.
1,000,000.
10,000.
1,000,000.
1,000,000.
1,000,000.

OTHER:

ANY AUTO
ALL OW NED
AUTOS

SCHEDULED
AUTOS
NON-OW NED
AUTOS

COMBINED SINGLE LIMIT


(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE
(Per accident)

$
$

UMBRELLA LIAB

OCCUR

EXCESS LIAB

CLAIMS-MADE

UL-20821515

08/31/2015 08/31/2016

EACH OCCURRENCE

AGGREGATE

$
$

10,000

A
B

DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below

PER
STATUTE

OTHER

Y/N

MEDICAL PROFESSIONAL
LIABILITY

20,000,000.

N/A

CPP-28200096

08/31/2015 08/31/2016

EO-000026628-02

08/31/2015 08/31/2016

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE $


E.L. DISEASE - POLICY LIMIT

EACH CLAIM
AGGREGATE

1,000,000.
1,000,000.
1,000,000.
$1,000,000.
$3,000,000.

DESCRIPT ION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

Sistema Universitario Ana G. Mndez certified that all students registered at Univrsidad del Este:
Carolina, Barceloneta, Cabo Rojo, Yauco, Arecibo, Santa Isabel; Universidad Metropolitana: Cupey,
Aguadilla, Bayamn, Jayuya, Comero; Universidad del Turabo: Gurabo, Yabucoa, Ponce, Isabela, Cayey
and Barceloneta are cover under the policies above stated.
CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED
CERTIFICATE HOLDER

HOSPITAL AUXILIO MUTUO


PO BOX 191227
SAN JUAN PR 00919-1227

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

ACORD 25 (2014/01)

MARITZA VAZQUEZ
1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD

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