Policy Number: Date Entered: 07/01/2023
DATE (M M /DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 07/01/2023
THIS CERTIFICATE IS ISSUED AS A M ATTER OF INFORM ATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRM ATIVELY OR NEGATIVELY AM E ND, 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.
IM P ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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
Seguros N. Colón, Inc.
NAM E: FONT INSURANCE 787-963-1450 100,711
FAX
PHONE
(A /C, No, Ext): (787)622-0034 (A /C, No): (787)622-0038
324 Ave. F.D. Roosevelt E-M AIL
ADDRESS: cvazquez@sncolon.com / Tel Ext 1014
Corner Teniente César González Street
INSURER(S) AFFORDING COVERAGE NAIC #
San Juan PR 00918, PR 00705 INSURER A : TRIPLE-S PROPIEDAD (B+; VIII)
INSURED UNIVERSIDAD DE PUERTO RICO &/OR ET ALS INSURER B :
TREASURY DEPT &/OR COMMONWEALTH OF PR INSURER C :
PO BOX 364984 INSURER D :
SAN JUAN, PR 00936-4984 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 INSD WVD POLICY NUM BER (M M /DD/YYYY) (M M /DD/YYYY) LIM ITS
A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.
DAMAGE TO RENTED
CLAIMS-MADE OCCUR CL-83049539-7 7/1/2023 7/1/2024 PREMISES (Ea occurrence) $ 100,000.
MED EXP (Any one person) $ 5,000.
PERSONAL & ADV INJURY $ 1,000 000.
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000.
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 3,000,000.
OTHER: $
AUTOM OBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
A UM BRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE UC-67006707 7/1/2023 7/1/2024 AGGREGATE $ 5,000,000
DED RETENTION $ 10,000 $
WORKERS COM PENSATION PER OTH-
AND EMPLOYERS' LIABILITY
STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000.
A OFFICER/MEMBER EXCLUDED? N N/A CL-83049539-7 7/1/2023 7/1/2024
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000.
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be atta ched if more space is required)
EVIDENCIA DE CUBIERTA
Vigencia: 1 de JULIO de 2023 al 1 de JULIO de 2024
Propósito: Centro de práctica para estudiantes del Sistema UPR.
CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED AS PER FORM 101 HERETO ATTACHED
CERTIFICATE HOLDER CANCELLATION
SH OULD ANY OF THE ABOVE DESC RIBED PO LICIES BE CANCEL LED BEF ORE
THE EXPI RATION DATE THER EO F, NOTICE WILL BE DEL IVER ED IN
Adriel Auto Carr. #3 km27.2 Rio Grande, PR 00745 ACCORDANCE WITH THE PO LICY PR OVI SI ONS.
AUTHORIZED REPRESENTATIVE
SEGUROS N COLON INC
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
This endorsement, effective 7/1/2023 forms a part of policy No. CL-83049539-7
Issued to. UNIVERSIDAD DE PUERTO RICO &/OR ET/ALS By TRIPLE-S PROPIEDAD
HOLD HARMLESS AGREEMENT
THE CONTRACTOR, FOR ITSELF, AGENTS, EMPLOYEES, SUCCESSOR AND ASSIGNS AGREES TO SAFE AND HOLD HARMLESS THE OWNER
FROM AND AGAINST ANY AND ALL CLAIMS, DEMANDS AND/OR SUITS WHETHER JUDICIAL OR EXTRA JUDICIAL FOR ANY CAUSE
WHATSOEVER ARISING OUT OF OR RELATED TO THE EXECUTION OF THE CONTRACT DESCRIBED BELOW, AND ITS INSURER SHALL
DEFEND THE OWNER FROM SUCH CLAIMS, DEMANDS AND/OR SUITS AND SHALL BEAR ALL THE EXPENSES FOR SUCH DEFENSE
CONTEMPLATED WITHIN THE COVERAGES AND LIMITS PROVIDED BY THE POLICY, EXCEPT WHERE SUCH CLAIMS, DEMANDS AND/OR
SUITS ARE DUE SOLELY TO THE NEGLIGENCE OF THE ADDITIONAL INSURED &/OR CERTIFICATE HOLDER.
Adriel Auto
THIS HOLD HARMLESS AGREEMENT DOES NOT EXTEND, MODIFY, INCREASE LIMITS OF, OR OTHERWISE ALTER THE COVERAGE PROVIDED
BY THIS POLICY.
ADDITIONAL INSURED
IT IS HEREBY UNDERSTOOD AND AGREED THAT Adriel Auto
IS INCLUDED AS ADDITIONAL INSURED UNDER THIS POLICY WITH RESPECT TO THE REFERENCE PROJECT AND AS PER ISO FORM
CG-2010 10 01 ATTACHED.
NINETY (90) DAYS NOTICE OF CA NCELLATION, NON-RENEWAL OR MATERIAL CHANGE CLAUSE
IT IS HEREBY U NDERSTOOD AND AGREED THAT IN THE EVENT OF ANY CANCELLATION, NON-RENEWAL OR MATERIAL CHANGE TO THIS POLICY AT THE
REQUEST OF THE INSURANCE COMPANY, INCLUDING NON-PAYMENT OF PREMIUMS, AT LEAST NINETY (90) DAYS PRIOR WRITTEN NOTICE BY REGISTERED
MAIL SHALL BE GIVEN TO THE INSURED.
Vigencia: 1 de JULIO de 2023 al 1 de JULIO de 2024
Propósito: Centro de práctica para estudiantes del Sistema UPR.
All other terms and conditions of this policy remain unchanged.
SEGUROS N COLON INC
Authorized Representative
1510 Ave. F. D. Roosevelt, Guaynabo, PR 00968
PO Box 70313, San Juan, PR 00936-0313
Tel. 787-749-4600 web www.ssspropiedad.com
CL-83049539-7
Adriel Auto UNIVERSIDAD
LAZA DE PUERTO
LAS AMERICAS INC RICO &/OR ET/ALS
C. With respect to the insurance afforded to these 2. A vailable unde r the applicable Limits of
additional insureds , the following is add ed to Insurance shown in the Declarat ion s;
Section Ill - Limits Of Insurance: whichever is less.
If coverage provided to the additional insured is This endorsement shall not inc rease the
requ ired by a contract or agreement , the most we appli cab le Limits of Insurance shown in the
will pay on behalf of the additional insured is the Declarations.
amount of insurance:
1. Required by the contract or agreemen t; or
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