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ACCORD
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
2/13/2019
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
THE ROWLEY AGENCY INC.
45 Constitution Avenue
PHONE
CONTACT Ronee Skillings
(603) 224-2562
EMAL ¥s: rskillings@rowleyagency.com
ies No): (603) 224-8012
1 .
P.O. Box 511 INSURER(S) AFFORDING COVERAGE NAIC #
Concord NH 03302-0511 INSURERA: Continental Western 10804
INSURED INSURERB:Union Insurance Company 25844
Sunshine Paving Corporation INSURERC:Acadia Insurance Company 31325
29 Constitution Drive INSURER D:
INSURER E :
Hudson NH 03051 INSURERF:
COVERAGES CERTIFICATE NUMBER:18-19 all lines 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 ic
Le TYPE OF INSURANCE NSD lwo POLICY NUMBER aamporreey | wawDbryry) LIMITS
X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE [x | OCCUR PREMISES (Ea occurrence) $ 300,000
| X | Contractual per CG0001 CPA 5230916-13 12/27/2018 | 12/27/2019 | MED EXP (Any one person) $ 15,000
| PERSONAL & ADVINJURY | $ 1,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
POLICY FRO LOC PRODUCTS - COMP/OPAGG | $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY & OMBINED SINGLE LIMIT $ 1,000,000
B X | anvauto BODILY INJURY (Per person) | $
AUTOS Sore ULED CAA 5230917-13 12/27/2018 | 12/27/2019 | BODILY INJURY (Per accident) | §
— NON-OWNED PROPERTY DAMAGE 3
HIRED AUTOS AUTOS (Per accident)
$
|X | UMBRELLALIAB =| X | occur EACH OCCURRENCE $ 10,000,000
c EXCESS LIAB CLAIMS-MADE CUA 5230924-13 12/27/2018 | 12/27/2019 | AGGREGATE $ 10,000,000
pep | X | RETENTION Q _ $
WORKERS COMPENSATION x | PER OTH-
AND EMPLOYERS! LIABILITY YIN STATUTE | ER
ANY PROPRIETOR/PARTNER/EXECUTIVE 3A STATES: NH/MA E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? [1s | NIA
B {(Mandatory in NH) WCA 5230925-13 12/27/2018 | 12/27/2019 | EL. DISEASE - EAEMPLOYEE | $ 1,000,000
lf yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000
A | LEASED/RENTED EQUIPMENT CPA 5230916-13 12/27/2018 | 12/27/2019 | LIMIT 250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
RE: 2019 Paving Program - Local & Collector Roadways. City of Nashua is additional insured with respects
to all liability policies, except Work Comp when required by written contract.
Waiver of subrogation
applies in favor of additional insureds on all liability policies where required by written contract and
permitted by state statute.
CERTIFICATE HOLDER
CANCELLATION
City of Nashua
229 Main Street
Nashua, NH 03061
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
Renee Skillings/RLS
Renae K Bolbinas..c81s
ACORD 25 (2014/01)
§NS025 (201401)
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