HomeMy WebLinkAbout47255 TXR000081205 000 11-01-2020 CORR AOO CERTIFICATE OF INSURANCE Pa9a 1 of 2
.acoRa� CERTIFICATE OF LIABILITY INSURANCE OAT10/26/3EIMIAOD"Y02YY,
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THIS CERTIFICATE 15 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(5), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the DMlicale holder Is an ADDITIONAL INSURED,the policy(lea)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 ce"Hlcate does not confer rights to the certificate holder In lieu of such em oreemen s.
PRODUCER XAME., Mill. T.. mt.. C9rt1f1ent9 C9ntet
•i111a Teeara utaen MDrtNaaat, ins. "NONE 1-BTT-966-T]T6 1-088-66T-23]6
c/o 26 OoacccY a1M 1: '1 N9:
P.O. Lot 305191 wrtlfiwC9eSti111LCw
Ntehv113e, Te 372305111 OY IX&ISE MMRmIN OOYIMOE NAIC9
WfJRERA: ACa ancetlaN Ineu — Cw l 22667
lmmo IN ERS: Ka PinpettY L CuUslEY 3osutenw Capeey 20699
taNey-alem Rest— inP.
eM It. effiltatw 11EIURERC: Mn 'ty Inepceow COy,enY of Mocto aced 63575
62 LOnvotet Drive IXBUMRD:
Norwell, No 0206i
INSURER E:
INSURERF,
COVERAGES CERTIFIOATE NUMBER:alemcss 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 GROWN MY HAVE BEEN REDUCED BY PAID CLAIMS.
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TA TYPEOFIWUMWE UBF PgJCYN1Wm
X CWMERCIALOMMALLMBIMTY
FACXOLLI]IPENCE i 21000,000
CLAIM"AOE O CCLUP p f 500.000
A X %CO LIED EXP me oo) S 10.00o
X Conttantoel ] ®0 O1165381A 11/01/2020 11/02/2"1 PERSOMLaADVINAIRY s 21000,000
GEN'L AGGREGATE UqMpMAPFUW PER: GENSULAGGREWTE 6 6,000.000
POLICY. X JECT LOO III PRODUCTS CCMPOPAGO 6 .1000,000
OTHER 6
AUTCMOMUE lMIV j I f 5,000.000
I
% ANY AUTO - 9DOILV IWUM IPergnon) f
A OWNED ECHULED x 11]
X AUTOS ONLY �AVTOBEO i6SJ10811 11/01/202011/01/2021 ODDILY INJURY IPera¢IOenll f
% HIRED X NCN-0WNED OPERTYDNAAGE g
X AT%ONLY AUTOSONLv pEdArL__.
f
X UMBRFIIAMAB X OCCUR EACHOCCURRENCE Y to,too.000
EXCESS UM _J CLAIM6'MADE 0468258" 006 11/01/2020 11/01/2021 MOREG_ATE_ _ g 101000,we
_F0E11 'g PETENiNf g _
____
WORNEfla 9AnpN X
AID FNPLOYERSYERB'LIgaNRY TAT ER __
C ANYPROPRIETMAARTNE"I"o On"' Y X 2,000,000
OFFICENMEMOEREXCLUDED'I O NIA RLR C6T159B1'I (AOBI 11/O3/3030 11/O3/2p33 E.L EACH ACCIOENi g
'nwosia YIn HN) E.L.DISEASE EARAPLOYEE_S 2,000,000
E.L.DEBLRIP
'NyMawnTIONb uM6ONkAS -_-- -__ 2,000,000
EPAT bbw D16EASE�POLICV LIMIT g
A Illocwte Compensation ID.R C67459e54 (M. NA) 11/01/2020 11/0112UL a.L. Leot Amiwnt $2,000,000
I!S C ployere Liability a.1. Diseue -Pnl 00,000
Pei etafote L.L. Biewu Le<t 113,000,000
CEeCRIIHICN Of OPENATOHB I LOCATIONS I VD MN(ADDED 101.Ansonia RM,tt eCMNIM.,to..W 11 cwwv. Fw le monad)
8copa of Work: all elicitation. of the Insutod.
the ATTgIC
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERFD IN
ACCORDANCE WITH THE POLICY PROVISI INS.
Alabw Dapartaant of tovitowancal Mtw9onc
AUTIpWIIDREPREBEMAME
Attn: PesING 6 8atvlws
1600 Colletw 0036 qua- 11�aN/t�2_
1400 Cell }L 03613
C 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
tt m: 20245301 aATu: 1863362
2012 420
AGENCY CUSTOMER ID:
LOC#:
AC RO oB ADDITIONAL REMARKS SCHEDULE Page 2 O/ 2
`� -
AGENCY NAMEDMSUREO
Millie I—.. Natecn Northeast, Inc. S.fNy-FLm 8yetw [nc.
aM it. aefiss.u.
POLICY NUMBER .I ic'.t.e o.i.n
sae Page 1 .—U. Me 02..1
CARRIER MAICCODE
... Page 1 Sas PNa 1 UFECTNED.TE:Sea Page 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORMNUMBER: 2s FORMTITLE: certieirac. .e Liability xn.arann.
Certificate Holder in named a. an Additional Insured for general Liability and Auto Liability as their interests may
appear if required by written Contract but only aitb rop.ct to liability aYi.i., out of operation. of the Named
Insured.
INSURER A660RDING COVERAGE: ACE Austin. Insurance CUMpany NAIC#: 22667
POLICY NUMBER: COO G21416603 006 a" DATE: 11/01/2020 E%P DATE: 11/01/2021
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Contractor's Pollution Liability Each Claim $10,000,000
All Claims $10,000,000
SIR $250,000
INSURER AYyOROING COVERAGE: ACE Anmrican Insurance Company MAIC#: 22661
POLICY NUMBER: COO G27416603 006 EPP DATE: 11/01/2020 E%P DATE: 11/01/2021
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Professional Liability Each Claim $10,000,000
All Claims $10,000,000
SIR $250,000
ACORD 101 (2008I01) 020M ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR Io: 20245301 BATCH: 1813362 CER1: .18427655
WILLIS TOWERS WATSON
26 CENTURY BLVD.
6TMFL- '
NASHVILLE,TN 37214
42481 MB 0.436
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ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEIK4NT
1400 COLISEUM BLVD
ATTN: PERMITS&SERVICES
MONTGOMERY,AL 36110-2400
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