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rCustomer Address - Persona Documentation/Persona Sample...persona, inc. / signup company\ranza, inc. / holien, inc.\r700 21st sw\rpo box 210\rwatertown, sd 57201-6445\r ... certificate

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Page 1: rCustomer Address - Persona Documentation/Persona Sample...persona, inc. / signup company\ranza, inc. / holien, inc.\r700 21st sw\rpo box 210\rwatertown, sd 57201-6445\r ... certificate
Insurance Company
12345
A
A
A
A
XXXXXX
XXXXXX
XXXXXX
XXXXXX
XX/XX/XXXX
XX/XX/XXXX
XX/XX/XXXX
XX/XX/XXXX
XX/XX/XXXX
XX/XX/XXXX
XX/XX/XXXX
XX/XX/XXXX
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1,000,000
2,000,000
2,000,000
1,000,000
1,000,000
1,000,000
The Umbrella policy must follow-form.
Persona, Inc. and its wholly owned subsidiaries, agents, affiliates, owners, officers, directors, and employees are additional insured on the General Liability policy on a
primary, non-contributory basis including ongoing and completed operations using ISO endorsements CG 2010 07/04, and CG 2037 07/04 or equivalent. Additional insured
on the Auto Liability policy. The General Liablility, Auto Liability, and Workers Compensation policies include a Waiver of Subrogation in favor of the additional insureds.
Statutory
Statutory
Statutory
Persona, Inc. / SignUp Company ANZA, Inc. / Holien, Inc. 700 21st SW PO Box 210 Watertown, SD 57201-6445
Customer Name Customer Address
Page 2: rCustomer Address - Persona Documentation/Persona Sample...persona, inc. / signup company\ranza, inc. / holien, inc.\r700 21st sw\rpo box 210\rwatertown, sd 57201-6445\r ... certificate
Page 3: rCustomer Address - Persona Documentation/Persona Sample...persona, inc. / signup company\ranza, inc. / holien, inc.\r700 21st sw\rpo box 210\rwatertown, sd 57201-6445\r ... certificate