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ACCORD
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CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
02/19/2021
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, 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
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 Pattee Fitzwilliam Account
The Frank Massin Agency Inc aioe, ext); (603) 585-3411 Ave, No); (803) 585-3413
32 NH Rte 119 Le.
P.O. Box 430 INSURER(S) AFFORDING COVERAGE NAIC #
Fitzwilliam NH 03447 INSURERA: UTICANATIONAL INSURANCE GROUP 43478
INSURED INSURER B; Utica Mutual Insurance 25976
Mark Dudley INSURERC:; Jravelers WC 00191
dba: Dudley Concessions INSURER D:
36 Camp Sergeant Road INSURER E:
Merrimack NH 03054 INSURER F:
COVERAGES CERTIFICATE NUMBER: = 2020-2021 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
LT TYPE OF INSURANCE ill Wwe POLICY NUMBER (MMDDIVYYY) | (MMIDDIYYYY) LIMITS
><| COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE gs 1,000,000
DAMAGE TO RENTED
Z| CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000
Eee MED EXP (Any one parson) $ 5,000
A CG1568629 09/04/2020 | 09/04/2021 | persona eapvinuury | § 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s_ 2,000,000
4} Poucy (| pro [| ae PRODUCTS -comPioPAGG | 2,000,000
OTHER: $
AUTOMOBILE LIABILITY GOMRINED SINGLE LIMIT s 1,000,000
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
B ee sii aoe 1569390 09/22/2020 | 09/22/2021 | BODILY INJURY (Per accident) | §
><} HIRED ><| NON-OWNED PROPERTY DAMAGE rs
|“) AUTOS ONLY AUTOS ONLY | (Per accident)
Uninsured motorist $ 1,000,000
UMBRELLA LIAB occur EACH OCCURRENCE s
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED | RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS’ LIABILITY “rn >< Stsure | [Ee sania
SE Eee NIA 6JUB-0320N01-0-20 04/11/2020 | 04/11/2021 LELEACHACCIDENT Ba
(Mandatory in NH) E.L. DISEASE -EAEMPLOYEE | $_ 100,000
If yes, describe under 500.000
DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT _| $ :
Concession Stand.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 104, Additional Remarks Schedule, may be attached If more space is required)
CERTIFICATE HOLDER
CITY OF NASHUA
229 MAIN ST
NASHUA
|
NH 03060
CANCELLATION
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 ee
ACORD 25 (2016/03)
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