—
ACORIEY
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
5/5/2017
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
certificate holder in lieu of such endorsement(s).
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
PRODUCER
THE ROWLEY AGENCY INC.
45 Constitution Avenue
P.O. Box 511
NAMED Peggy J ohnson
PHONE ext}; (603) 224-2562
Ce ss. PI ohnson@ Irowleyagency . com
(Ai, No}: (603) 224- ~8012
NAIC #
i __.... INSURER(S} AFFORDING COVERAGE _
Concord NH 03302-0511 INSURER A ‘Travelers Indemnity Co 25658
INSURED INSURERS ‘Travelers Prop Cas Co of Amer 25674
George R. Cairns & Sons, Inc. INSURER C ‘Travelers Indemnity Co of CT 25682
8 Ledge Road INSURERD: i
INSURERE: _
Windham NH 03087 INSURER FE:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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.
— : ADD -
ell TYPE OF INSURANCE ‘(ADDL SUBRI
Taman EFF pane EXP
LIMITS
LINSD | WvD POLICY NUMBER MIDDIVYYY) | {MMIDD/YYYY}
x | COMMERCIAL GENERAL LIABILITY : EACH OCCURRENCE $ 1,000,000
i DAMAGE TO RENTED “— nna
AD | CLAIMS-MADE 1x, | OCCUR ! PREMISES (Ea occurrence). $_ __ 300,000
‘ ! DTCO7615C131IND16 9/30/2016 | 9/30/2017 _MED EXP (Any one person) 'g 5, ,000
Per Project Aggregate '§ a, ,000, 000.
_GENL AGGREGATE — PER: Applies Only If Required 3 Ss _ £1900 , 006
_ POLICY | x ES | LOG By Written Contract PRODUCTS - COMP/OP AGG | 8 2,000,000
i | OTHER: Employee Benefits $
COMBINED SINGLE LIMIT
| AUTOMOBILE LIABILITY (€aaccident) ,3 4,600,000
A a | ANY AUTO i BODILY INJURY ¢ er r person) _$
| ALL OWNED 1 eee DT8107615C131IND16 9/30/2016 | 9/30/2017 | BODILY INJURY (Per accident) | $
x) i x | NON-OWNED » PROPERTY DAMAGE —_ 3.
/HIRED AUTOS | | AUTOS (Per accident) _ ce
| : ' Uninsured motorist st Bl-single 5
XUMBRELLALIAB = =X occuR EACH OCCURRENCE | $_ 5,000,000.
BL | EXCESS LAB | CLAIMS-MADE. .AGGREGATE 8 5,000,000.
| DED : Ix) | RETENTION $ 10,000 DTPSMCUP7615C131TIL16 9/30/2016 } 9/30/2017 $
"WORKERS COMPENSATION 3A States: CT,MA,NH,VI,ME Xx /RER OTH
AND EMPLOYERS' LIABILITY YIN ® ‘ . STATUTE PERO woes se
[ANY PROPRIETOR/PARTNERVEXECUTIVE 71 : i E.L. EACH ACCIDENT $ 1,000,000
-OFFICER/MEMBER EXCLUDED? LN ENTA ver ns we es
C (Mandatory in NH) ) DTEUBT6L5C1311CT16 9/30/2016 | 9/30/2017 EL. DISEASE -EA EMPLOYEE $ | 1,000,000
‘if yes, describe under i : ue we
_DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000 ,o00
RE: Crown Street Park & Ride (13117)
additional insureds with respect to general and auto
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
{IFBO0657-041317) .
City of Nashua and McFarland Johnson are
liability, when required by written contract. A
waiver of subrogation applies to general and auto liability, when required by written contract.
CERTIFICATE HOLDER
CANCELLATION
City of Nashua
Purchasing Department
City Hall
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
Peggy Johnson/PAJ Utagyy on a .
ACORD 25 (2014/01)
INS025 (901.401)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and iogo are registered marks of ACORD
