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ACCORD
Wa
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
4118/2022
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 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
PO BOX 8° Co of Opelika ha ext), 334-749-3401 FAX oy: 334-745-8785
Opelika AL 36803 its: lisa.benefield@marshmma.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Zurich American Insurance Company 16535
INSURED ; INSURER B : Great American Insurance Compan 16691
Southworth-Milton, Inc. Pany
Milton CAT INSURER C :
100 Quarry Dr. INSURER D :
Milford MA 01757 INSURERE :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 2016618139
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 | wvpD POLICY NUMBER (MMIDD/YYYY) | (MM/DDIYYYY) LIMITS
A | X | COMMERCIAL GENERAL LIABILITY y | y | Glo292517814 21112022 21112023 | EACH OCCURRENCE $ 1,000,000
ry | DAMAGE TO RENTED
| CLAIMS-MADE | X | OCCUR PREMISES (Ea occurrence) _| $ 300,000
X Contractual Liab MED EXP (Any one person) $ 10,000
7 PERSONAL & ADV INJURY __ | $ 1,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
|X ] pouicy [ |B RRO. x | Loc PRODUCTS - COMP/OP AGG | $ 2,000,000
X | OTHER: PER PROJ PER CON $
COMBINED SINGLE LIMIT
A | AUTOMOBILE LIABILITY y | vy | BAP292517914 21112022 21172023 | (OM ent) $ 5 g00 000
X | any AUTO BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED ;
aioe [| Autos BODILY INJURY (Per accident)| $
K PROPERTY DAMAGE
HIRED AUTOS X AUTOS (Per accident) $
$
8 UMBRELLA LIAB X | occur y | y | TUuU367410515 21112022 21112023 | EACH OCCURRENCE $ 25,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 25,000,000
veo | X | ReTENTIONS 40.000 $
A _|WORKERS COMPENSATION Y | we292519109 21112022 21/2023 | X | RER OTH.
AND EMPLOYERS’ LIABILITY VIN STATUTE | | ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OFFICERIMEMBER EXCLUDED? [N] NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE] $ 1,000,000
If yes, describe un
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1014, Additi R
may be attached if more space is required)
GENERAL LIABILITY AGGREGATE LIMIT WILL ONLY APPLY ON A PER PROJECT BASIS IF REQUIRED BY WRITTEN CONTRACT PER FORM
CG25030509. GENERAL LIABILITY AGGREGATE LIMIT WILL APPLY PER LOCATION PER FORM CG25040509.
CERTIFICATE HOLDER
CANCELLATION
City of Nashua — City Hall; Risk Managemrnt
229 Main Street
Nashua NH 03060
1
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
F par BIR + IR SE
ACORD 25 (2014/01)
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