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ACCORD
ene
CERTIFICATE OF LIABILITY INSURANCE
DATE (UM/DDYYY YY}
ONI2018
=
THIS CERTIFICATE IS ISSUED AS A PAATTER 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 HOLOER.
HAFORTANT: Mf the certlicate holder is an ADDITIONAL INSURED, the policytios} must have ADDITIONAL INSURED provisions or be endorsed,
If SUBROGATION (S WAIVED, subject to the terms and conditions of the policy, certain policias may require an endorsement. A statement on
this cortificate does not confer rights to the certificate holder in Neu of such endorsamant{s}.
PRODUCER GORTACT Brian Robillard
sr Pulman siieet FONE, an. 508-756-5159 [2 wo, 608-751-8747
Worcester MA 01606 Shovkss, carlificatas@henthygroup.com
INSURERS) AFFORDING COVERAGE HAIC
imnsuRERa: Travelers insurance Company
‘MHQ,. inc., et al HARRM INSURER B: Lloyds
401 Elm Street INSURER C
Marlborough MA 01752-4566 INSURER D:
INSURER E :
INSURER F ¢
COVERAGES CERTIFICATE NUMBER? 316862912 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 WHIGH THIS
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORGED AY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS.
KODE POLICY EFF] POLICY
oR TYPE OF INSURANCE ieptuaa| POLICY NUMBER gaporn imumorrrn uuirs
A 1X Tecoumercus cenerar UABIUTY y | ¥ [aapaxssune T2018 72019 | exCHOCCURRENCE 5 1,900,000
J) cLamsaane |X | occur | PREWISES (Ea conirence) | § 100.000
MED EXP (Any one person) 310,000
PERSONAL AAGV:HURY__| $ 1.000.000
GENT AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE $3,000 000
X | povcy L_| BF Loc PRODUCTS -COMP/OP AGG | 3 3,000,000
OTHER $
A | AUTOMOSLE LIABILITY Y | ¥ | Apansaraty TAZO88 72019 | AMERED SINGLE Tait 1s ¢ 000.000
ANY AUTO BOOILY INJURY {Per person) | 5
"| owneo SCHEDULED
Rene Sc BOOILY INJURY (Per aceraant)| $
KX | MRED X | NONOMNED OPERTY DAMAGE 3
|X | AUTOS ONLY AUTOS ONLY ier poawen
$
¥ wyriect TAOLB 12019
A [|X] UMBRELLAUAB | X | occur ZUP: 25 ¥ EACH OCCURRENCE 5 25 000,000
X | Excess uas CLARAS-MADE AGGREGATE $25,900,000
pep | X | revennon$ won $
WORKERS CORPENSA RON | een gE f | OFM
AND EMPLOYERS" UABILITY vin ER.
ANYPROPRIGTOR/PARTHER/EXECUTIVE EL BACH ACCOENT $
OFFICERUMEMBER EXCLUDED? HIA <a
[Mandatory In 8H] EL DISEASE -EAEMPLOYEE| $
if yns, cronies unde :
DESERIBTION OF OPERATIONS dalow EL DISEASE - POLICY Lantt | 5
A | BPP sap bsiow ¥ 620-4K950488 7HQ016 THOS {515.445 645 $5 000 Deckuctitte
B | Dealers Physca! Damaga Y VOSAPO00082-02 TAQ FRO — | $437 605.464 31.000 Decuctite
Equpment Floaier Y $600,000 080 Dedyctibie
$5,000 Deductible.
Auto Only Umit: 1,000,000
DESCRIPTION OF OPERATIONS {LOCATIONS { VEHICLES [ACORO 161, Additional Remarke Schedule, may be attached lf mace space le required]
Property/Equipmant Floater for Toots - Policy 630-8K959488- $600,000 Limit, Speciat form Including Thefl. Replacement Cost, $5,000 Deducilbte.
BPP - Blanket Business Personal Property Limlt including Leased and Rented Equipment - $11,445,645, Special form inctuding Theft, Replacement Cost,
Pollution Liability - Policy# G46870533 001 Chubb Group of insurance Companies - $1,000,000/$1,000,000, Subject to $10.000 Deductible
Sea Attached...
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ASOVE GESCRIBED POLICIES SE CANCELLES BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
MAPC and GBPC
AUTHORIZED REPRESENTATIVE
eo fF thstis, He
ACORD 25 (2016/03)
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