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HomeMy WebLinkAboutScanned on 04/05/2017 at 15:20:38 CI ient#: 23493 TARS E 1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/21/2016 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 BYTHE 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 I 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: Meghan Fitzsimmons ust Insurance Agency, LLC PHONE Ext:202 776-5015 FAIc No): 202 776-1288 510 H Street NW,5th floor E-MAIL mfitzsimmons@rustinsurance.com ashington, DC 20005 202 776-5000 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Western World Insurance Co. :NSURED INSURERS:T®riS Specialty Ins.Co. 1313Taxs Dv Capital Services LLC INSURERC:Travelers Casualty&Surety Co 1313 Dolley Madison Blvd INSURERD:Navigators Specialty Ins.Co. LL-130 McLean,VA 22101 INSURER E: 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 CONTRACTOR 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. IPTR TYPE OF INSURANCE ADDNSRLSUBR WVD POLICY NUMBER MMIDDYYYYY MM/LDIDYr'YYYY LIMITS A GENERAL LIABILITY BRP0002480 12/31/2015 12131/2016 DDEACCMH��OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISE To o cunence $50 QOQ CLAIMS-MADE ®OCCUR MED EXP(Any one person $ X BI1PD Ded:1,000 PERSONAL&ADV INJURY $1 000000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1,000,000 POLICY PE� LOC $ A AUTOMOBILE LIABILITY BRP0002480 12/31/2015 12/31/201 EOacccl den SINGLE LIMIT 1 QQQ 000 ANY AUTO BOD ILY INJ URY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS E NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ B UMBRELLA LIAB OCCUR 75084A155ALI 12/31/2015 1213112016 EACH OCCURRENCE s2,000,000 X EXCESS LIAB X I CLAIMS MADE AGGREGATE s2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ NIA $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Fidelity Bond 106034381 1213112015 1213112018 $2,000,000 D Professional NY15MPL0318051C 12131/2015 1213112016 $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Town of South Windsor,CT is an Additional Insured. CERTIFICATE HOLDER CANCELLATION Town of South Windsor,CT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1540 Sullivan Ave ACCORDANCE WITH THE POLICY PROVISIONS. South Windsor,CT 06074 AUTHORIZED REPRESENTATIVE 4 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S59404/M56409 MAF � �� � � � � � � i � � � � � � �� �