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CERTIFICATE OF LIABILITY INSURANCE
WFGRACE-01 KPETTIT
DATE (MMIDDIYYYY)
02/02/2018
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
Davis & Towle Morrill & Everett, Inc.
115 Airport Road
Concord, NH 03301
CONTACT Kathy M. Pettit
Bee, ext); (603) 715-9739
| FAX 1,.):(603) 225-7935
| Favii.s. Kpettit@davistowle.com
INSURER(S) AFFORDING COVERAGE NAIC #
insurer A:ACadia Insurance Company 31325
INSURED INSURER B :
W. F. Grace Construction, LLC INSURER C :
29 Tandy Road INSURER D :
Deerfield, NH 03037
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.
i TYPE OF INSURANCE apps ever POLICY NUMBER EUSA | aReeh ee Ltrs
A | X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
CLAIMS-MADE OCCUR xX CPA5010773-16 08/15/2017 | 08/15/2018 | PAMAGETORENTED is 300,000
| MED EXP {Any one person) $ 5,000
|__| PERSONAL & ADV INJURY __| § 1,000,000
| GEN'L AGGREGATE Lar APPLIES PER: GENERAL AGGREGATE $ 2,000,000
|__| poucy |X| [ x) 58 weet [X | toc PRODUCTS - COMP/OP AGG | $ 2,000,000
OTHER: $
A | auTomoBILe LABILITY COMBINED SNGLELEAIT | 1,000,000
X | ANY AUTO 'CAA5011368-16 08/15/2017 | 08/15/2018 | sopiLy InsURY (Per person) _| §
| | OWNED SCHEDULED
| | AUTOS ONLY AUTOS BODILY INJURY (Per accident) | $
PROPERTY DAMAGE
RS FEB ONLY NON Se NEY (Per accident) $
$
A |X| umprewauas | X/ occur EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE (CUAS5010775-16 08/15/2017 | 08/15/2018 AGGREGATE $ 5,000,000
pep | X | RETENTIONS 0 $
A |WORKERS COMPENSATION X | PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
ANY PROPRIETORIPARTNERIEMECUTIVE Po” IWPA5011369-16 08/15/2017 | 08/15/2018 | - | acu accwENT 5 1,000,000
(thant ae NED EXCLUDED? NIA 1,000,000
Mandatory in NH} E.L. DISEASE - EA EMPLOYEE! § mas
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY Limit | § 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Scheduie, may be attached if more space is required)
** Workers Compensation ** - 3A Siates: NH, MA, VT.
RE: Emergency sewer repair at 38 Bridge Street, Nashua, NH. It is agreed and understood that the City of Nashua is included as additional insured on
General Liability for ongoing operations when required by written contract.
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
ACORD 25 (2016/03)
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