Client#: 865001 GATECITY
ACORD.. CERTIFICATE OF LIABILITY INSURANCE 2123/2000
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER . GONTACT
USI Insurance Services LLC PHONE x», 855 874-0123 FAS. Noy
3 Executive Park Drive, Suite 300 E-MAIL
ADDRESS:
Bedford, NH 03110 INSURER(S) AFFORDING COVERAGE NAIC #
855 874-0123 INSURER A; Phoenix Insurance Company 25623
INSURED INSURER B ; Travelers Property Cas. Co. of America 25674
Gate City Electric, LLC INSURER C ; Travelers Indemnity Company of CT 25682
PO Box 3554 INSURER D; St. Paul Surplus Lines Insurance Co. 30481
Nashua, NH 03061 INSURER E: Travelers Indemnity Company 25658
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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.
Re TYPE OF INSURANCE Noe SB POLICY NUMBER (MADEN YYY) (MMIDBIYYYY) LIMITS
A |_X| COMMERCIAL GENERAL LIABILITY DTCO3P117740PHX21 01/01/2021 | 01/01/2022 EAcH occURRENCE $1,000,000
| CLAIMS-MADE OCCUR PAMIBES ee Etsnca) | $300,000
| XI PD Ded 12,500 MED EXP {Any one person) $10,000
|_| PERSONAL & ADV INJURY | $1,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
|_| POLICY [ x] trot [ ] Loc PRODUCTS - COMP/OP AGG | $2,000,000
OTHER: $
E | AUTOMOBILE LIABILITY BA3P09505A2126G 01/01/2024| 01/01/2022 For CEM | 51,000,000
X ANY AUTO BODILY INJURY (Per person) | $
| | ONE ONLY | | SCHEDULED BODILY INJURY (Per accident) | $
|_X} AUS onty |X | AGtos ONLY | (Peraccuent) YO" $
X (Drive Oth Car $
B | X| UMBRELLALIAB | X | occur CUP4P7547992126 01/01/2021 | 01/01/2022 EacH occURRENCE $10,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000
DED | x| RETENTION $10000 $
C_ | WORKERS COMPENSATION vin UB3P1189822126G 04/01/2021 01/01/2022 x [EFkue | (SR
ANY PROPRIETOR/PARTNERIEXECUTIVE NIA EL. EACH ACCIDENT $500,000
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE| $500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LimiT | $500,000
D |Professional ZC061N35915 101/01/2021/01/01/2022 $1,000,000 Each Claime
Liability $2,000,000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requlred)
** Workers Comp Information **
ABC00105021 Eff Date: 01/01/2021 Exp Date: 01/01/2022
WC Each Accident Limit: $1,000,000
WC Policy Limit: $1,000,000
WC Each Employee Limit: $1,000,000
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
City of Nash SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
fly or Nashua THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Hall-Accounting Dept. 229 ACCORDANCE WITH THE POLICY PROVISIONS,
Main Street
Nashua, NH 03060 AUTHORIZED REPRESENTATIVE
l Sea hd
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ACORD 25 (2016/03) 1 of 2. The ACORD name and logo are registered marks of ACORD
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