DATE (MMIDDIYYYY)
——" ®
ACCORD CERTIFICATE OF LIABILITY INSURANCE 7/20/2017
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 NCT 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 CONTACT vivian Pinette
FIAI/Cross Insurance FONE ext, (603) 669-3218 (Are, No): (603) 645-4331
1100 Elm Street EMAIL .g: vpinette@ crossagency.com
INSURER(S) AFFORDING COVERAGE NAIC #
Manchester NH 0310601 INSURERA:Centrai Mutuai Ins Co 20230
INSURED INSURER B ‘Massachusetts Bay Ins Co 22306
INSURER C:
Northeast Resource Recovery INSURER D:
2101 Dover Rd INSURER E:
Epsom NH 03234-4147 INSURER F :
COVERAGES CERTIFICATE NUMBER:7/17-10/17 short term 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 (MMIDD/VYYY) | (MM/DDIYYYY) LIMITS
X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
A a CLAIMS-MADE [ x | OCCUR PREMISES (Ea occurrence) _| $ 300 , 000
x CLP 9655554 7/12/2017 | 10/1/2017 | MED EXP (Any one person) | $ 5,000
PERSONAL & ADV INJURY | $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X | PoLicy FES: Loc PRODUCTS - COMP/OP AGG | $ 2,000,000
OTHER: Hired/borrowed $ 1,000,000
AUTOMOBILE LIABILITY (auccdent MT | s 1,000,000
A ANY AUTO BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED i
AUTOS AUTOS CLP 9655554 7/12/2017 | 10/1/2017 | BODILY INJURY (Per accident) | $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (Per accident)
$
X | UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
DED | | RETENTION $ CXS 9655555 7/12/2017 | 10/1/2017 $
WORKERS COMPENSATION x | EER OTH-
AND EMPLOYERS! LIABILITY YIN starute |__| ER
ANY PROPRIETOR/PARTNER/EXECUTIVE [ax | NIA E.L. EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED?
B | (Mandatory in NH) WDVD290430 7/12/2017 | 10/1/2017 | EL. DISEASE - EA EMPLOYES $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below State: NH E.L. DISEASE - POLICY LIMIT | $ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Confirmation of Coverage.
required by written contract.
City of Nashua is included as additional insured on General Liability when
CERTIFICATE HOLDER
CANCELLATION
City of Nashua, NH
Risk Management Department
229 Main St
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
J Schneiderman/DL3 verter te ee
ACORD 25 (2014/01)
INSO025 (901401)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
