DATE (MM/DDAYYYY}
eo
ACORD CERTIFICATE OF LIABILITY INSURANCE oaios/2020
THIS CERTIFICATE 15 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 feu of such endorsement(s}.
PRODUCER CONTACT Judith George CIC.CPIW,CRIS
FIAI/Cross Insurance PHONE, exn, (603) 669-3218 TAG, no}: (603) 645-4331
1100 Elm Street Eibkess: igeorge@crossagency.com
(NSURER{S) AFFORDING COVERAGE NAIC #
Manchester NH 03101 INSURER A: S€#lective Insurance Co, of America 12572
INSURED INSURERB; Selective Insurance Co of Southeast 39926
Stephens-Marquis Associates, inc. INSURERC:
717 Daniel Webster Highway INSURER D:
INSURER E :
Merrimack NH 03054 INSURER F:
COVERAGES CERTIFICATE NUMBER: 19-20 Alllines REVISION NUMBER:
THIS 1S 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 HERE!N IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REQDUCED BY PAID CLAIMS.
ADSL SVER
Ne TYPE OF INSURANCE NSH wb POLICY NUMBER (MAIDDIYYYY) | GAMO DIRTY) Limtrs
><] COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000
AMA Ni
CLAIMS-MADE OCCUR PREMISES (Ea occurrence} g 500,000
— MED EXP (Any one person} $ 15,000
AT $2336788 07/09/2019 | 07/09/2020 | seaconataapvinjury |g 1,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g_ 2,000,000
|__| Power ier Loc propuCTSs-compioracs | s 2,200,000
OTHER: 8
COMBINED SINGLE Liat
AUTOMOBILE LIABILITY eo NOLE LIMIT s 1,000,006
>< Any AUTO BODILY INJURY (Per person) | $
[| OWNED SCHEDULED ;
A |__| AUTOS ONLY AUTOS $2336788 OF/01/2079 | 07/01/2020 | BoDiLy INJURY {Per accident) | §
HIRED NON-GWNED PROPERTY DAMAGE $
|_| AUTOS ONLY ALITOS ONLY | (Per accident)
Medical payments $ 5,000
[OS] UMARELLAUIAB | 3€! occur EACH OCCURRENCE s_ 2,000,000
A EXCESS LIAB CLAIMS-MADE $2336788 07/01/2019 | 07/01/2020 | sccrecate g 2,000,000
DED | | RETENTION § $
WORKERS COMPENSATION PER ‘OTA
AND EMPLOYERS’ LIABILITY YIN >[Sikure | [88 7000 000
B |SrrcERMEMBER EXCLUDED? NIA WC9059244 (3a.) MA NH RI 07/01/2019 | 07/01/2020 [EL EACH ACCIDENT $e
(Mandatory in NH} EL DISEASE-EAEMPLOvEE | 5 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLCY Limiy jg [000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 701, Additional Remarks Schedule, may be attached if more space is required}
Project: Nashua DPW Fue! Facility, Nashua, NH. The City of Nashua, NH is included as additional insured with respects to CGL and business auto policies
on a primary and non-contributory basis as required by written contract with named insured. Notice of cancellation to the certificate holder is 30 days, 10
days for non-payment, with respects to CGL, business auto and umbrella policies.
_CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREB IN
City of Nashua, NH ACCORDANCE WITH THE POLICY PROVISIONS,
229 Main Street
AUTHORIZED REPRESENTATIVE
NH 03060-2019
Nashua
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