®
ACORD
(—
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
09/23/2021
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 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 lieu of such endorsement(s).
PRODUCER
CONTACT |;
NAME: Linda Dacey, CIC
PHONE - FAX Z
FIAVCross Insurance PHONE: yt), (603) 669-3218 FAX No): (603) 645-4331
E-MAIL
1100 Elm Street Appress: Manch.Certs@crossagency.com
INSURER(S) AFFORDING COVERAGE NAIC #
Manchester NH 03101 INSURERA: Continental Western Ins Co 10804
INSURED INSURERB: Acadia Ins Co. 31325
Boucher Acoustic, LLC INSURER C:
695 Mast Road, Unit #3 INSURER D:
INSURER E:
Manchester NH 03102 INSURER F:
COVERAGES CERTIFICATE NUMBER: 21-22 All Lines - Boucher 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 | WD POLICY NUMBER (MM/DDIYYYY) | (MM/DDIYYYY) LIMITS
x< COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
| CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 300,000
MED EXP (Any one person) $ 10,000
A CPA5251874-15 04/29/2021 | 04/29/2022 | personaLaapvinsury |g 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g_ 2,000,000
POLICY aE Loc propucts-compiopace | 5 2:000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $s 1,000,000
(Ea accident)
><| ANY AuTO BODILY INJURY (Per person) | $
OWNED SCHEDULED - |
A OWNED ly SCHED CAA5251875-15 04/29/2021 | 04/29/2022 | BoDILY INJURY (Per accident) | $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
D<| UMBRELLA LIAB ><] occur EACH OCCURRENCE g 9,000,000
B EXCESS LIAB CLAIMS-MADE CUA5251876-15 04/29/2021 | 04/29/2022 | ,aorecaTe 5,000,000
DED | | RETENTION $ $
WORKERS COMPENSATION | PER OTH-
AND EMPLOYERS' LIABILITY YIN STATUTE ER 7000000
BO CROMCNIBER OXCLUDLDD OU TIVE NIA WCA5251877-14 04/29/2021 | 04/29/2022 | EL. EACHACCIDENT go
(Mandatory in NH) E.L. DISEASE -EA EMPLOYEE | ¢ 1,000,000
If yes, describe under 1.000.000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ [mY *?
WC (3a.) states: MA ME NH VT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
City of Nashua, New Hampshire 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
City of Nashua, New Hampshire
229 Main Street
Nashua
l
NH 03060-2019
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
ACORD 25 (2016/03)
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