HomeMy WebLinkAbout673 Ellington Road - Building Plans & Dr 04/25/2011 15:55 8GO3435479 ROVBAL #FIRE EQUIP L B #4686 P. 002/010
CERTIFICATE OF LIABILITY INSURANCE 4/l/2011
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 0Y 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: 0 the certificate holder Is an ADDITIONAL INSURED,the policytles) 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 endorsements.
PRODUCER Corey PontlOAlli
Independent Insurance Center, Inc, PHo B�X (66D)646-6050 PAX (A6016a 6-6d3tl
B30 Hartford Road 'M°IL .coray.ponticellimiicinsuro.com
PRODUCER p0003223
M=Chester CT 06040 INSURFRISI AFFORDING COVERAGE NAICtl
INSURED INSU ERA;Fir8t Mercury Ins Cc
INSURER a:
Roybal & Sons Fire Equipment Company INSURERC:
P.O. Sox 204 INSURER D:
INSURER E:
Middlefield CT 06455-0204 INSURER F
COVERAGES CERTIFICATE NUMBER:Ch114100082 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VWTH 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.
1 SR TYPE OFINSURANCE u ER 015100 F POLICY EX LIMITS
GENERAL LIABILITY POLICY EACH OCCURRENCE 5 110001000
X COMMERCIAL GENERAL Lh1BAJTY Of S 50,000
A CLAIMS•MADE OCCUR X GLVALD0257910 /1/2011 /1/2012 MED EXP RD areal $ Excludad
PERSONAL&AOV INJURY $ 1,000,000
GENERAL AGGREGATE 6 2,000,000
GEITL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO, $ 2,000,000
X POLICY PRa LOC1
S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accidenll
ANY AUTO BODILY INJURY(ParPamm) B
ALL OWNED AUTOS BODILY INJURY(Per acatoon1) $
SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS IPa Acaidenl) $
NON-OWNED AUTOS S
X UMBRELLA LIAE OCCUR EACH OCCURRENCE $ 2 000,OOO
EXCESS LIAS CLAIMS-MADE AGGREGATE S 2,000,000
DEDUCTIBLE $
A X RETENTION YO 000 X E2VAL00257,900 /l/2011. /1/2012 $
WoRRERs COMPENSATION WC STATU- OTH•
AND EMPLOYERS'LIABILITY yy�I rub
OFFICERNEIMBER EXCLUDDE/DEIfECUTIVE N/A E.L EACH ACCIDENT 3
(Meadelory In NN) E.L.DISEASE•EA EMPLOYE
If yyea.daaaige under
ESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT
DESCRIPTION OF OPERATIONS/LOCATIONS J VEHICLES (AMen ACORp 101,AddlManal Bamndn Sahadule,if more Apace IA roAulred)
The Town of Eaet Hartford is additional inured for Ganaral Liability per form CG 20 33 (copy attached) .
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of East Hartford ACCORDANCE WITH THE POLICY PROVISIONS.
Attention; Building Department AUTHORIZED REPRESENTATIVE
740 Main Street
East Hartford, CT 06108
C Pontioelli/COREY Q�aes o:IL
ACORD 25(2009109) 0 i9884009 ACORD CORPORATION. All rights reserved.
IN8026(20000e) The ACORD name and logo are registered marks of ACORD
04/25/2011 15:55 8603435479 ROVBAL #FIRE EQUIP L B #4688 P. 001/010
P O'Box 204,Widdlefeld,CT.U6455-204
Tel: 860347-2189 •
Fax:U60-3435479 . , .�* :� :.' •.. Sons
Email-Suono @rovbalfire Equipment
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Phone: Pages:
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Q Urgent Fl For Review ❑ Please Comment F1 Please Reply ❑ Please Recycle,
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Thank you
ROYBAL & SONS FIRE EQUIPMENT CO.
P.O. BOX 204 (860)347-2189
MIDDLEFIELD, CT 06455-0204 Fax (860)343-5479
st t
Sw xxti`
Test of Pre-Engineered Chemical Fire Protection System
Date of Test:
Installation Name: "/r rp
Address: ; , ( T.a"'i C ,—
System Type:.. �4 _u! h'1 t -
Authority Requiring Test: 4
Address: &ILS14 (t
Type of Test: 0l Mechanical Test 1111*� Cartridge Test
❑ Discharge Test ❑ Other
Yes No N/A/
❑ / ❑ O' Electrical Equipment Shuts Off.
O� ❑ ❑ // Gas Equipment Shuts Off
El Or Supply .Air Fan Shuts Off
13 / ❑ Connection to Building Fire Alarm Completed
❑/ ❑ ❑ System Passed
O O C) Exceptions: 1
_Service Technician:
Name J �Sign re _
Witness:
e Signature
04/25/2011 15:57 8803435479 ROVBAL AFIRE EQUIP L B #4686 P. 010/010
r il. ANSIIL. I tgcu R-102 RESTAURANT SYSTEM
NOZZLE COVERAGE/OVERLAPPING SUMMARY SHEET
Width Length Nozzle Placement Min. Max,
Nozzle Flow (In) (In) (Sea Manual Height Height
Plenum 7Ype Points Max.Side Max-Side for More Detail) (in) . (In)
Horizontal Protection Single Bank 1 N 1 48 120 0 in—6 in from end of plenum 2 4
r Perpendicular Protection Single Bank 1 W 1 48 48 See Manual for more detail 1 20
Horizontal Protection V•Bank 2 x 1 N 2 48 120 0 In—6 In from and of plenum 2 4
r HorlZenial Protection v-Bank 1 W 1 48 72 0 in—6 in from and of plenum 1/3 the height of filter
r Perpendicular Protection vBank 1 W 1 48 48 See Manual for more detail i 20
Nozzle Placement Duct
Nozzle Flow Perimeter Diameter (See Manual Length
Duct Type Pointe (In) (in) for More Detail) (In)
r Single Nozzle 1 Flow Nozzle 1 W 1 50 16 See Manual for more detail Unlimited
Single Nozzle 2 Flow Nozzle 2W 2 too 31 7/6 See Manual for more detail Unlimited
Multiple Nozzle 2W m 1 W .3 139 48 Sea Manual for more detail Unlimited
Multiple 2W Nozzle 2W — >136 >13S See Manual for more detail Unlimited
R-102 OVERLAPPING PROTECTION I r�
r The 246 nozzle,'Pan No-4151340,must he used for"nnd of zone'protection,
and the 260 nozz*Part No.419341,must be used for"zone^protection,
COVER MUST NOY I I (0-305 Min)
Type Maximum Cooking Hazard INTERFERE WITH 1 /
EDGE OF
Fryer 34 in'(864 mm)Deep x 5.6 ft2(.54 sq2) 61SMIANOEPA-rrE I (4P49 N
Griddle 30 in(762 trim)Deep x Unlimited Length !
r Range 30 in(762 mm)Deep x Unlimited Length I !
Wok,Maximum 30 in(762 mm) Diameter x 8 in(203 mm)Deep
Wok,Minimum 11 in(279 mm)Diameter x 3 in(76 mot)Deep I ZONE
Braising Pan/Tilt Skillet 34 In(954 mot)Deep x Unlimited Length I f
Lava Rock Char-broiler 20 In(660 mot) Deep x Unlimited Length anexv
Charcoal Broiler '30 in(762 mot)Deep x Unlimited Length
(4 in(102 mm) Maximum Fuel Depth)
r Mesquite Wood Broiler 30 in.(762 mm)Deep x Unlimited Length - ZONE CENTER GINF
r IS in(152 mm)Maximum Fuel Depth) FIGURE 1
Gas Radian Char-Broiler 36 in(914 mot) Deep x Unlimited Length
Electric Char-Brazier 34 in(864 mm) Deep x Unlimited Length
Sea Figure 1 for nozzle location.
r Note:Group protection option is required for appliances on either side of an appliancei(s)using dedicated protection—see manual for details.
Overlapping System Piping Limitations
Total Max.3/8 in Max, Maximum
System Flow Pipe No-of Elevalion Cartridge
Size Numbers Length Rlbows Rise Size
2 Gallon 6 75 ft 25 loft 1-T40-R
(22•9 m) (3.1 m)
6 Gallon 12 75 ft 25 10 If Double
Manifol4ed 122.9 m) (3,1 m) Tank
50 ft(15,2 m)maximum pipe from first to last nozzle. '
50 ft(15.2 m)maximum pipe after the split on a split system.
r
ANSUL INCORPORATEO�ONE STANTON STREEr,MARINME,WI 5414E-2542 715.7a5.7411 Farm W.P-2009010.1 copyright 02007 Aneul Intorpareted
04/25/2011 15: 58 8603435473 RUYBAL #FIRE EQUIP L B #4686 P. 009/010
' tl, ANSUL. I two R-102 RESTAURANT SYSTEM
NOZZLE COVERAGEIOVERLAPPING SUMMARY SHEET
Width Length Multiple Nozzle Multiple Nozzle Min. Max.,
Nozzle Flow (In) (In) wc/Drip Board w/Drip Board Nozzle Ht. Nozzle Ht.
} Appliance Type Points Max.Side Max.Side Area in2 Area fn2 (in) (in)
Fryers without drip boards 230/290' 2 14 15 — — 27/13 47/16
"Low Proximlry Split or No Split Vat r 245290' 2 14/141/2 15(14 — — 20/16 27/27
Fryers without drip boards 1 290 2 19112 19 — — 13 16
Non-Split Vat(ONLY) 3N 3 19 112 19 — — 21 34
3N 3 18 18 — 25 35
Fryers with drip boards 230/290• 2 14 21 210 294 i
6a.Pla5mity Split or No Split Vat' 245/290' 2 14/14 1/2 21/2612 21 W03 294/384.2 18 �2727
Fryers with drip boards' 200 2 19.5 253/8 370.5 495 16
Non-Split Val(ONLY) 3N 3 19.5 25318 370.5 495 34
3N 3 18 27 35
Tilt SKUIoWraising Fans Coverage limitation are based an fryer sizes including the drip boards.
a00pton:Tilt Skillets and Braising may exceed the maximum of 6 ft2
i LDruest Side Max,Area Sq.In. —
Range I 1 12 32 384 3o 40
Without back shelf I 1 12 28 336 30 $0
With back shelf° I 1 12 28 336 — 40 48
246 2 24 28 — — 40 5o
i Without back shelf 260 2 + 24 32 768 = 30 40
With back shelf' 260 2 12 32 384 30 40
2 x 290 4.' 36 28 1008 -- 15 20
Griddle 1N/1 NSSI 7 1 36 1 30 1 — — 35 40
290 2 30 24 — — 30 50
260 2 48 30 — — 3o 50
290 2 48 30 — — 20 30
2120 2 . 48 3o — — 10 20
Chain Bre"eH 2 x 1 W 2 34 30 — 10 26
(Over tection)head Pro
Chain Broiler 2 x 1 N 2 31 43 — — Front edge;1.3 in.
(Horizontal Protection) above the chain
Char Broiler Gas-Radiant 1N/1NSS 1 24 36 — — 15 40
Electric 1N/1NSS 1 20 34 — — 20 5o
Lava-Rack 1N/1NSS 1 13 24
Natural Charcoal' 1N/i NSS 1 12 24 — — 18 40
Lava-RocK or Natural Charcoal' 3N 3 24 30 — — 14 40
Wood Fueled' 3N 3 24
Upright Broiler 2 x 1/2N 1 30 32.5 Fron[edge;
Salamander Broiler 2 x 12N 1 30 32.6 — _ above the grata
I 1 16 29
1N nozzle location to be on the vertical edge 8 to 12 in.in front and 0 to 12 In. above the top of broiler
Internal Chamber 1N 1 16 29 — — 6.12 in.above either end
Wok 3.75 to B In deep 1260 2 14 in.to 30 In.diameter — — 35I 45
3 to 6 in deep 1 N/1 NSS 1 11 in.to 24 in.diameter
'For multiply nozzle protection of single fryers,see detalled Information on pages 4-S to 4-11 of manual
See Figure 1 for nozzle location.
'Minimum chain broiler exhaust opening—12 in x 12 In(31 cm x 31 cm),and not leas Iran 60%of rnramal.brojler size.
'4 in 002 mm)maximum luel depth.
6 in(15 cm)maximum fuel depth.
Shelf can overhang bumer(s)by maximum of 11 In(28 cm)and height limitation 0120 in(51 am)Iram bottom o1 lowesl part of shelf to the lop of burner grate.
JI 7 shelf can overhang burners)by maximum of 11 in(28 cm)and height limitation of 18 in f46 cm)from bottom of lowest pad of shelf to the tap of burner grate.
f'Low Proximity
04/25/2011 15:56 8803435478 ROYBAL #FIRE EQUIP L B #4686 P. 008/010
-tqc"1 Fire& R-102 RESTAURANT SYSTEM � ��
Security pISTRIBUTI�N PIPING REQUIREMENTS SHEET
Distribution Piping Requirements-6,0 Gallon Mantolded system
Duct Plenum Appliance
Requirements supply One Branch line Branch Line Branch Line
Pipe Size 3/S In. 3/8 in. 3/8 in. 3/8 in.
Maximum Length 32 ft. (9.7 m) S ft,(2.4 m) 4 ft.(1,2 m) 12 fl.(3.7 m)
Maximum Rise 6 ft.(1.8 m) 4 if. (1.2 m) 2 ft. (.6 m) 2 f6 (.6 m)
Maximum 90°Elbow 8 4 4 8
Maximum T86S 2 2 2 4
Maximum Flow Numbers 22
4 2 4
Distribution Piping Requirements-6.o Gallon System
1- .The maximum length between the start of the first branch line and the stan of the last branch line must not exceed 24 ft.(7.3 m).
When the supply line Is split,the combined total of both legs of the supply line(from the start of the first branch fine to the start of
the last branch line)Must not exceed 24 it-(7.3 m).
2. The total length at all branch lines must not exceed 36 ft.110.9 m).
2.. use a 3/8 in.union to connect the tank adaptor to the 3/8 In.supply Ilrle.
Distribution Piping Requirements-9.0 Gallon System ..
Duct, Plenum appliance
Requirements supply Line Branch Line Branch line Branch Line
Pipe Size 3/8 in. 3/8 In. 318 In. 318 in.
Maximum length 40 fk(12.2 m) 8 ft.(2.4 m) 4 ft.(1 z m) 12 ft.(3.7 m)
Maximum Rise 6 h.(1.8 m) 41t. (1.2 m) 2 ft. (.6 m) 2 ft.(.6 m)
Maximum 900 Elbow 9 4 4 6
Maximum Teas 1 .2 2 4
Maximum Flow Numbers 11• 4 2 4
"Exceptions:
1. Twelve(12)flow numbers are allowed in any one tank not containing two-flow appliance nozzles,and/or,a 1N nozzle for wok or
griddle protection,and/or, a IF or 1 N nozzle for range protection, and/or,a 3N nozzle for fryer protection.
2. Twelve(12)flow numbers are allowed in any one tank for head and duct protection.
3. Twelve(12)flow numbers are allowed with any one tank using only two-flow appliance nozzles.
4. Twelve(12)flow numbers are allowed with any one tank using only lhrse-flow,appliance nozzles.
Special Instructions:I. Twelve(12)flow numbers are allowed when tour(4)Dean Industries GTI Gas Fryers are protected at low proximity,
2. For certain McDonald's applications, 11.5 flow numbers are allowed when using a combination of one(1)2W duct nozzle,one(1)
1/2N electrostatic precipitator nozzle,One (1) 1N plenum nozzle,and four(4)two-flow appliance nozzles.Contact ApSLII
Applications Engineering Department for additional information.
Distribution Piping Requirements-9.0 Gallon System
1. The maximum length between the start of the first branch line and the start of the last branch line must not exceed 24 It. (7.3 m).
When the supply line is split,the combined total of both legs of the supply line (from.the start of the first branch line to the start OI
the last branch line)must not exceed 24 it.(7.3 m).
2. The total length of all branch lines must not exceed 36 ft.(1 o,B m),
3. use a 3/8 in.union to connect the tank adaptor to the 3/a In.supply line.
General Piping Requirements
1- All R-102 system piping is straight line.Therefore,the need for critical lengths and balancing is minimized.
2. Two 45-elbows count as one go`elbow.
3, Each Oration line Includes the tea or elbow leading to it,and all fittings within the branch line itself.
4. The minimum piping length o1 Schedule 40,3/8 in,pipe from the tank outlet to any nozzle protecting a range,fryer,or wok must be
6 ft.(1.8 m).
5. Pipe lengths are measured from center of fitting to center of fitting.
6. All distribution piping must be Schedule 40 black iron,chromaplatad,or stainless steel. Do not use hot dipped galvanized pipe on
the distribution piping.
7. All tnreaded connections located in and above the protected area must be sealed with pipe lape.Tape should be applied to male
threads only.Make certain tape does not extend over the and of the thread,as this could cause possible blockage of the agem
distribution.
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04/25/2011))II 15:58 8G03435478 ROVBAL #FIRE EQUIP L B #4888 P. 007/010
tq C/IFire& R-102 RESTAURANT SYSTEM =J. APJSgL:
Security DISTRIBUTION PIPING REQUIREMENTS SHEET
Distribution Piping Requirements-1.5 Gallon System
> Duct Plenum Appliance
Requirements Supply Line Branch Line Branch Lino Branch Line
Pipe Size 3/31n. 3/8 in. 3/8 in. aB in.
Maximum Length 40 ft. If 2.2 m) 6 ft.(1.6 m) 4 ft.(1.2 m) 10 ft.(3 m)
Maximum Rise 8 h.0.8 m) 4 ft.(1.2 m) 2 ft. (.6 m) 2 ft.(.6 m)
_ Maximum 900 Elbow 9 4 4 6
Maximum Teas 1 1 2 3
Maximum Flow Numbers 5• 2 2 3
`Exceptions:
t. Six(6)flow numbers are'allowed when a duct branch line is the last branch line on the piping network and no IN nozzles,Pan No.
56930,are used to protect woks or griddles.
2. Six(8)flow numbers are allowed when six(5)IN nozzles,Part No.56930,are used and none of the nozzles are used to protect
woks and griddles.NOTE: Only five(5)flow numbers are allowed if a 1 N nozzle is used for wok or griddle protection.
3. Six(6)flow numbers are allowed when only two(2)aN nozzles, Part No.76702,are used.
Distribution Piping Requirements-1.6 Gallon System
1. This option allows for duct protection,plenum protection,appliance protection,or any combination.
2. When using a combination of plenum and duct protection only,only one duct nozzle,either a 1 W,1100,or a 2W,may be used.
3. The maximum length between the start of'tic"uat branch line and the start of the last branch line must not exceed 8 ft.(9^m).
When the supply line is split,the combined total of both legs of the supply line(from the start of the first branch line to the start of
the last branch line)must not exceed 8 ft.(2.4 m).
4. The total length of all branch lines must not exceed 22 ft.(6.7 m). 4 ,
5. Use a W8 in.u01on to connect the tank adaptor to the W8 in,supply line.
Distribution Piping Requirements-3.0 Gallon System
Duct Plenum Appliance
Requirements Supply Line Branch Line Branch Line . Branch Line
Pipe Size 3/6 In. 3/8 in. ate jn. 3/8 In,
Maximum Length 40 ft. (12.2 m) 8 ft. (2.4 m) 4 ft.(1.2 m) 12 it.(3.7 m)
Maximum Rise 6 ft.(1.8 m) 4 ft. (1.2 m) 2 ft, (,6 m) 2 ft.(.6 m)
Maximum 90'Elbow 9 4 4 S.
Maximum Tees 1 2 2 4
Maximum Flow Numbers 11' 4 2 4
`Exceptions:
1. Twelve(12)Flow numbers are allowed in any one tank not containing two-flow appliance nozzles,and/or,a 1 N nozzle for wok or
griddle protection,and/or,a 1 F or 1 N nozzle for range protection,and/or,a 3N nozzle for fryer protection.
2. Twelve(12)flow numbers are allowed In any one tank for hood and duct protection.
3. Twelve(12)flow numbers are allowed with,any one tank using only two-flaw appliance nozzles.
4. Twelve(12)flow numbers are allowed with any one tank using only three-flow appliance nozzles.
Special Instructions:
1. Twelve(12)flow numbers are allowed when four(4) Dean Industries GTI Gas Fryers are protsoled at low proximity.
2. For certain McDonald's applications, 11.5 flow numbers are allowed when using a combination of one(1)2W duct nozzle,one(1)
1/2N electrostatic precipitator nozzle,one (1)iN plenum nozzle,and four(4)two-flaw appliance nozzles.ContactAnsul
Applications Engineering Department for additional information.
Distribution Piping Requirements-3.0 Gallon System
f. The maximum length between the start of the first branch line and the start of the last branch line must not exceed 24 h.(7.3 m).
When the supply Ijne is split,the combined total of bath legs of the supply line(from the start of the first branch line to the start of
the last branch line)must.not exceed 24 ft. (7.3 m).
2. The total length of all branch lines must not exeead•36 ft.(10.9 m),
S. Use a 3/8 in. union to connect the tank adaptor 10 the 3/8 In.supply line.
04/25/2011 15:56 8603435473 RUVBAL #FIRE EQUIP L B #4886 P. 006/010
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04/25/2011 15 :56 8603435479 ROYBAL #FIRE EQUIP L B 14866 P. 004/010
33 Forest St.,
Middleti)wn,CT o6457
860-347-ZI89 08x: $60-343-5479
CT Lic.,F30004 MA Ur-001071 RI LCc.55J309A
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and all applicabla Mate and local� dc -
LicenseY—
Date�^
04/25/2011 15:55 8603435479 ROYBAL #FIRE EQUIP L B #4686 P. 003/010
ACORD D MMIDDrYYYY)
,ACORD CERTIFICATE OF LIABILITY INSURANCE 03131/2011
PRODUCER Ppone: 8669g8.8811 FA. aBC.Sa76772 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
RICE DAVIS DALEY&KRENZ INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
50 WASHINGTON ST. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND,OR
MIDDLETOWN CT 06467 .GE AFFQaW&.W.=F.POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIL 0
INSURED INSURERAL Hartford Ins.
DREAMERS UNLIMITED INC INSURER 6: Hartford Ins.
OBA ROYBAL&SONS FIRE EQUIPMENT INsuRER a Hartford Ins.
PO BOX 204 INSURER D:
MIDDLEFIELD CT 06465 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE L18YED FEEdW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR INCL ROD INDICATED, NOTWITHYfKNOING
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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE OEM REDUCED BY PAID CLAIMS
NOR AP` TYPE OF INSURANCE POLICYNUMBER PoUDYEPAACTIVE POUW EXP=Tlom LIMITS
L1R INS OA
GENERAL LIABR.tri EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMATsETP FEMEP $
PRENISEE ra uwPlccBl
CLAIMS MADEE OCCUR MED.EXP(AAY one paiwil $
PERSONAL B ADV INJURY $
GENERALAGGREGATE $
GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS•COMFICP AGO. $
PRO-
POLICYM-JECTLOC S
AUTOMOBILE LIABILITY 02UECUF6894 03/28/11 09/28112 COMBINED SINGLE LIMIT
4
X ANYAUTO (EAseelaent) $ 1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULEDAUTOS (ParpanwJ S
HIRED AUTOS BODILY INJURY
$
NON-OWNEDAUTOS (PweaideM)
PROPERTY DAMAGE $
(Per accident)
GARAGE LABILITY AUTO O ACCIDENT $
ANYAUTO OTHERTHAN EAACC $
AUTO ONLY: AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION$ 71-1 $
WORKERS COMPENSATION AND 02WECNKS799 04/01/11 04/01112 lM Y CINITB °TMO'
EMPLOYERS'LIABILITY
C E.L.EACH ACCIDENT S 1,000,099
ANYPROPRIET0WWTNERI UTNE
dFRCEMMEMBER EXtLUDEP? E.L DISEASE,EAEMPLOYEE $ 1,000,000
spEcIsivpoavisioeria Daow E.L.DISEASE-POLICY LIMIT $ 1,000,000
OTHER:
DESCRIPTION OF OPERATIONS/LOCATIONSAIEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
TOWN OF EAST HARTFORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDFAVOR TO MAIL 1a DAYS
ATTN:BUILDING DEPARTMENT WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,PUT FAILURE TO
740 MAIN ST DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS
EAST HARTFORD,CT 06106 AGENTS OR REPRESENTATIVES.
AUTHORIZED RFPRFSFNTATlVF
Attondon. Kr✓nz ..r"�
ACORD 25(2001/08) Certificate# 59485 0 ACORD CORPORATION 1988