Document 9LorbwY2z1BwKe1GwE5d37606

PLAINTIFFS E X H IB IT WCD-216 ^ R A N C E COMPANY OF NORTH A m Q lA AND PACIFIC EMPLOYERS GROUP OF INSURANCE COMPANIES CERTIFICATE OF INSURANCE (This C ertificate o f Insurance neither a ffirm a tive ly nor negatively amends, extends Sift* il ta Certifg ta or alters the coverage, limits, terms or conditions o f the policies it certificates.) D ire c t any in q u ir ie s re g ard in g t h is to th e R is k Management & co m pany codes c e r tific a te I- WHITTAKER, CLARK & DANIELS INC. I n s u r a n c e D e p t . ' o f P f i z e r I n c . 1000 C o o lid g e S tr e e t [ 3 A L U E D INSURANCE C O . S o u th P l a i n f i e l d , New J e rs e y 0 INA OF TEXAS L _J th a t the fo llo w in g d e scrib e d p o lic y or p o lic ie s , issu e d by T he C om pany as coded b e lo w , p ro v id in g in su ra n ce o n ly for hazards checked by " X " b e lo w , hove been issu e d to : P f i z e r I n c . - MPM D i v i s i o n ADDREs;l235 E a s t 42nd S t r e e t , New Y o r k , N .Y. 10017 in s u r e d ' co ve rin g in a ccordan ce w ith th e term s th e re o f, a t the fo llo w in g lo c a tio n (s ): 0 PACIFIC EM PLO YER S INSURANCE CO. 0 INSURANCE CO M PANY OF NORTH AMERICA 0 INA INS. CO. OF IL L IN O IS 0 INA INS. CO. OF O H IO (OTHER; --S P E C IF Y ) TYPE OF POLICY (a) Standard Workmen's Compensation & Employers* L iab ility (b) General L iab ility P r e m is e s --O p e ra tio n s ( in c lu d in g " I n c id e n ta l C o n tra c ts " as d e fin e d below ) H A Z A R D S CO.CODE POLICY NUMBER ALB 47262 Independent C ontractors C om pleted O p e ra tio n s /P ro d u c ts C o n tra ctu a l, (S p e cific type as d e scrib e d in fo o tn o te b elow ) P r e m is e s --O p e r a tio n s ( I n c lu d in g " In c id e n ta l C o n tra c ts " as d e fin e d b elow ) Q See Below .O . H 0 ALB 47262 Independent Contractors Cxi C o m pleted O p e ra tio n s /P ro d u c ts C o n tra c tu a l, (S p e c ific ty p e as d e s c rib e d in fo o tn o te b e lo w ) (c) Automobile L ia b ility tj 3 O 'w n e d A u to m o b ile s Hi re d A u to m o b ile s N on-ow ned A u to m o b ile s X See Below 0 POLICY PERIOD 10-1-77 UNTIL CANCEijLciD 10-1-77 UNTIL CANCELLED LIMITS OF L IA B IL IT Y S ta tu to ry W . C . One A c c id e n t and A g g re g a te D ise a se Each Person .*1,000,000Each I 1 A cc id e n t I x l O ccurrence A g g re g a to --C o m p le te d O p e ra tio n s /P ro d u c ts ,oo6ach 1i S l j C O O I I A c c id e n t lX l O ccurrence t $ J_ y 5 0 0 y O O fifag regato--Prem ./Oper. $ ** A ggregat --Protect ivo 1 A g g re g a t --C o m p le te d O p e ra tio n s /P ro d u c ts ** A g g r e g a t -- C o n t r o c t u o l Each P rso n I I A c c id e n t - 1s | f | &O w ned A u to m o b ile s S| Hire d A u to m o b ile s N o n -oo ww n e d AAiu to m o b ile s (d) V i, uOu, uuu combi ned s i n g l ^ both combined. '2)Blanket Contract u al. lim it pers<j>nal in ju r y i O Accident E a c h *< -- . I L J O ccurrence 3r p ro p e rty dam age o r PLEASE SEE REVERSE SI DE Contractual Footnote: Subject to a ll the p o lic y term s a p p lic a b le , s p e c ific con tra c tu a l coverage is provided as respects / Check \ D a contract 'j I Applicable l[^! purchase order agreem ents \ betw een the Insured and: \ Block I n a ll contracts 1 It is the in ten tio n of th e company th a t in th o e v e n t o f ca n c e llatio n of the p o licy or p o lic ie s by the c o m p a n y , te n (10) days* w ritte n n o tic e of such c a n c e lla tio n w i l l be g iv e n to you at the address stated above. NAME OF OTHER PARTY D A T E (IF APPLICABLE) C O N T R A C T N O . (IF A N Y ) D E S C R IP T IO N (OR JOB) Definitions: "Incidental contract" means any written ( | ) lease of premises (2) easement agreement, exe.+ fions on or adjacent te a railroad, (3) undertaking to indemnify a municipality required by nu icti pa I ord the municipality, (4) sidetrack agreement, or (5) elevator maintenance agreement. 111. LC-138SC P T D . IN U.S.A. 1. O R IG IN A L construction or dem o litio n operaon n e ctio a with work for izad R e p re s e n ta tiv e PFZ01162 012499