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ACCORD
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIODIYYYY)
4/18/2022
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).
PROOUCER COR LAGT
J Smith Lanier & Co of Opetika PHONE
334-749-3404 FAS oy, 334-745-8785
P. 0. BOX 828 cry :
Opelika AL 36803 | aporess, lisa.benefield@marshmma.com
INSURER(S) AFFORDING COVERAGE NAIC 8
INSURER A: Zurich American Insurance Company 16535
INSURED insurer : Great American Insurance Company 16691
Southworth-Milton, Inc.
Milton CAT INSURER C
100 Quarry Dr. INSURER 0 ;
Milford MA 01757 INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 2016618139
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE 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 ISSUEO OR MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN !$ SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL|SUGR POLIGY EFF | POLICY EXP
LTR TYPE OF INSURANCE INSD | Wyo POLICY NUMBER (MMIDOVYYY) [{MMDDIVYYY) LIMITS
A |X | COMMERCIAL GENERAL LIABILITY y | ¥ | cuozsesi7a14 2112022 212023 | EacH OCCURRENCE $ 1,000,000
c)
| crams.maoe | X | occur PREMISES (Ea occurence) | $ 300,000
X | contractual Liab MED EXP (Any ona person) —_| $ 10,000
PERSONAL & ADVINJURY _| $ 1.000.000
GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000
X | eouicy Fao |X | Loc PRODUCTS - COMPIOP AGG | $ 2.000.000
% | OTHER: PER PROJ PER CON $
COMBINED SINGLE LIMIT
& | AUTOMOBILE LIABILITY y | y | gap2e2si7a14 212022 anv2023 | COMBINED $ 2 090.000
X | any AUTO BODILY INJURY (Per person) [| $
ALL OWNED SCHEDULED ;
Ko fures oe SROPERTVOCE te
x HIRED AUTOS AUTOS (Par accident) $
$
6 | X | UMBRELLA LIAB x occur ¥ ¥ | TuU367410515 2/1/2022 22023 EACH OCCURRENCE $ 25,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 25,000,000
pep | X | RETENTIONS 10.000 $
A [WORKERS COMPENSATION y | woze2s1e109 21912022 avzo23 «6 | x | EER one
bee EMPLOYERS’ LIABILITY ni
Y PROPRIET OR/PARTNERVEXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OEFICERVMEMBER EXCLUDED? NIA
(Mandatary in bial E.L. DISEASE - EA EMPLOYER $ 1,000,000
H yes, describa und:
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1.000.000
DESCRIPTION OF OPERATIONS [ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedul may be attached if more space Is required}
GENERAL LIASILITY AGGREGATE LIMIT WILL ONLY APPLY ON A PER PROJECT BASIS IF REQUIRED BY WRITTEN CONTRACT PER FORM
CG25030509. GENERAL LIABILITY AGGREGATE LIMIT WILL APPLY PER LOCATION PER FORM CG25040509.
CERTIFICATE HOLDER
CANCELLATION
City of Nashua — City Hall: Risk Managemrnt
229 Main Street
Nashua NH 03060
J
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
PP ETETR X-RAaSE
ACORD 25 (2014/01)
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The ACORD name and [ogo are registered marks of ACORD
