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ACCORD
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDYYYY}
11/13/2020
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 GOES 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 RONTACT Lisa Lee
Avery Insurance FHONE exp, (003) 869-2515 inc, Noy; (603) 569-4266
21 South Main Street EMAIL, lisal@averyinsurance.net
PO Box 1510 INSURER(S) AFFORDING COVERAGE NAIC #
Walfebaro NH 03894-4510 | incumer a. Covington Specialty Ins Co 13027
INSURED INSURER 5. Chio Security Insurance Company 24082
NORTH CCAST SERVICES LLC INSURER ¢: Nautilus Insurance Company 17370
Insurer go: Phe Ohic Casualty Insurance Company 24074
44 LOCKE RD INSURER E: astern Alliance 10724
a CONCORD NH 03801 INSURERF: ‘Omeland Insurance Company of New York 34452
COVERAGES CERTIFICATE NUMBER: — ©L20111310521 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN {SSUED 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 i$ SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADDL SUBR. POL P
ie TYPE OF INSURANCE INSD | WVD POLICY NUMBER MMDDYYY) (UMD) UMITS
><} COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000
DAMAGE TO RENTED
| CLAIMS-MADE OCCUR {_ PREMISES (Ea occurrence) $ 300,000
MED EXP (Any one person) $ 15,000
A BKS57590729 42/01/2020 | 12/04/2021 | oersonaLaapvinvury |g 1-000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g 2,000,000
>] eoucy [| reo. [| Loc PRODUCTS-comPropAGG | ¢ 2-000,000
OTHER: $
AUTOMOBILE LIABILITY Poe EDP NGLE LIMIT s 1,000,060
ANY AUTO BODILY INJURY (Per person} | §
OWNED SCHEDULED , ; -
B OWNED oly SCHED BAS57590729 12/01/2020 | 12/01/2021 | BODILY INJURY (Per accident) | §
>¢| HIRED ><] NON-OWNED PROPERTY DAMAGE 5
AUTOS ONLY AUTOS ONLY (Per accident)
Uninsured motorist $ 1,000,000
><] UWBRELLA LAB occur Ren oCURAENCE | 3,000,000
S EXCESS LIAB CLAIMS-MADE USOS7590729 12/01/2020 | 12/01/2021 | aceregate g 3:000,000
DED | | RETENTION § $
WORKERS COMPENSATION | PER | OTH-
| AND EMPLOYERS’ LIABILITY YIN STATUTE ER
ANY PROPRIETORIPA
E Grice MENaER Ce MERE RECUTIVE NIA 09000123255-02 42/01/2020 | 12/01/2021 LE EACH ACCIDENT § _
andatary in NH 00,000
if yas, describe under EL DISEASE -EAEMPLOYEE | $
DESCRIPTION OF OPERATIONS below E.L DISEASE -Poucy umm | ¢ 999,000
Pollution Liability Limit $1,000,000
F 793-00-74-19-0000 01/12/2020 | 0142/2022 | Deductible $10,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Coverage as per terms and conditions of policy. Refuse and Recycling Hauler. 3A Stated NH, ME, MA, VT, Wi & N¥. Thomas Fatcheric and William
Andrews are excluded from WC
CERTIFICAFE HOLDER
CANCELLATION
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
ACORD 25 (2016/03)
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