Board Of Aldermen - Agenda - 5/25/2021 - P150
05/07/2021
@ DATE (MM/DD/YYYY,
ACORD 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 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).
PRODUCER BONTACT Tara Dean, CIC
FIAI/Cross Insurance iG Nb, Ext, (603) 669-3218 (AIG, No): (603) 645-4334
1100 Elm Street EMAL ss: Manch.Certs@crossagency.com
INSURER(S) AFFORDING COVERAGE NAIC #
Manchester NH 03101 INSURERA: Massachusetts Bay Ins Co 22306
INSURED INSURER B: Hanover Ins Co. 22292
Hoyle, Tanner & Assoc., Inc. INSURER CG: MEMIC Indemnity Company 11030
150 Dow Street INSURER D:
INSURER E:
Manchester NH 03101 INSURER F:
COVERAGES CERTIFICATE NUMBER: = 20-21/21-22WC 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 NUMBER (MM/DD/YYYY) | (MM/DD/YYYY) LIMITS
x< COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
| CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ 10,000
A ZDVH087921 10/01/2020 | 10/01/2021 | personaLaapvinuuryY |g 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g_ 2,000,000
POLICY oEo. [| Loc propucts-compiopace | § 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
{_ (Ea accident)
ANY AUTO BODILY INJURY (Per person) | $
OWNED SCHEDULED |
A OWNED Ly | | SCHED ZDVH087921 10/01/2020 | 10/01/2021 | BODILY INJURY (Per accident) | $
><} HIRED. ><} NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
D<| UMBRELLA LIAB ><] occur EACH OCCURRENCE g 10,000,000
B EXCESS LIAB CLAIMS-MADE UHVH057400 10/01/2020 | 10/01/2021 | scorecaTe 10,000,000
DED | | RETENTION $ $
WORKERS COMPENSATION | PER OTH-
AND EMPLOYERS’ LIABILITY YIN STATUTE ER 7000000
CO CR meNIBe ONC URED OO TVE NIA 3102807127 05/01/2021 | 05/01/2022 [EL EACHACCIDENT go
(Mandatory in NH) E.L. DISEASE -EAEMPLoyEE | g 1,000,000
If yes, describe under 1.000.000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ YY»
WC (a.) States: CT DE FL MA ME NH
NY RI VA VT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Project: Engineering Services for Highway, Bridge, Traffic and Bicycle/Pedestrian Infrastructure. City of Nashua is included as additional insured with
respects to CGL as required by wirtten contract with named insured. Notice of cancellation to the certificate holder is 30 days, 10 days for non-payment, with
respects to CGL.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Nashua ACCORDANCE WITH THE POLICY PROVISIONS.
229 Main St
AUTHORIZED REPRESENTATIVE
*
8
Nashua NH 03060
| Lan KZ
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