Loading...
HomeMy WebLinkAboutApplication and WC e -� J �` ` ' �; : ; A ��s��Y1I?I0.3�i0�QIS 2I�H,LO�.L�'IdL1I0�Ql�t�2I�A0 i�t?If13,�SV�'Id��a�a�� ; oo-o�� = ��zQ iunorn� S�$ ���u����du 56$ 07�dgQ.L� Ob$ .L2I�SS�Q AI�Z02Id— 08$ '8'bs 000`SZ> � SZ$ QQ03-IJI�IIQN�A SZZ$ '8'bs 000`SZ< OS$ '8'bs OS> 9 #ZIW2I�d ��3 Q�IInd�2i�SN��I'I #.LIW2I�d ��d Q�2IIf1a�I�SI�I��I'I #.LIY�i2I�d �� ! 08$ N�H�.I.I�I'QIS�2I— ���IAZI�S'II�'.L�2I , 08$ �'IdS�'IOHM af9Q� 09$ '�IA NOY�IY�IO�� 09I$ SJ.H�S OOI< o�$ J,I30ZId-I�ION S£$ -�irc�r�iiNo�— �3�,��� sa$ sidas oot-o j � #J:1Y�i2I�d ��3 Q�2IIfla�2i�SI�I��I'I #.LIY�I2I�d ��3 Q�2IIf1a�I�SN��I'I #.LIY�RI�d ��3 Q�2IIf1(7�2I�SN��I'I ���IA2I�S Q00.3 (�-TP=�� ��a08$ 'IOOd'RIIHM� SOI$ �I2Idd 2I�'IIF�2I.L SS$ �IJQO'I^ Zh�'�a08$ 'IOOd JI�IIY�iY�IIMS Z SS$ dWd� SS$ I�INI � �0- >� ss$ �aiow j ss$ r�i�� ss$ g�g � #.LIY�RI�d ��3 Q�2III1d�2I�SN��I'I #.LIY�I2I�d ��d Q�2IIf1��2I�SI�I��I'I #.LIY�I2I�d ��d Q�2IIf1a�2I�SN��I'I ��AII�QO'I �zuo �sn �ai�,�o #��io.l. ��rui��s sN�xn�.l.s� �� � �-v ��� '� �"!� �� �-,--v� �Z � j�-�v�-t�� 'i •ssautsnq�o a��jd ano�;� ai� � ui�;ui�ut pu� saidoa n�au apinoad;snu� no� •spaoaaa �s.��a�f�s�d asn�oa Iiin��uaui��daQ q;i�ag aqs •uuo�siu�o�suot����ia.zao aaAoiduza�o saido�u���� pere nnoiaq sampa�oad�utxou�-t�u�ut paurea�saa�fojduza.zno,i�sii as�aid •saiui�ii��� sastuza.�d au}uo�zannauey� u�iiunaH au� ui paut�a� aa�iojduza auo �s�ai �� an�u �snua aaouz ao s��as sZ u�uin s�uauzustiq��sa a�inzas poo� itF� �SNOI.I,�'�I3I,L2I�� H�I'IL�iI�H _ _ �_ _ __r�.��__a=�::��_ --_ --- --.�. - - �z � ��► ��J �-� f l '"a s°��/ t •uot��aado�o smou�ut.znp a�is uo (�I� a�reu� uI uosaad auo�s�ai}� an�u�snuz�uauzustiq��sa poo�uo�g ���J2I�'H�I�II NOS2I�d z L ° �/ �► J �4 �.j a�as�o� �j ' •;aaucqsiiq��sa ano�f;� ai� � ui�;ui�tu pu� saidoa n�au apino.�d;smm �o� •spaoaa.��s.��a�;s�d asn;ou iiins�uaiu;a�daQ q;i�ag aqZ •uoi���tidd�stu� o�uoi����t�a��o satdo�u����as�ajd 'OQO'06S 2IY�I� SOI `s�uauzustiq��sg a�in�as poo3 ao� apo� ��nz�s a���s au� ut pau�ap s� `aa��cre�uoi��a�oad poo3 � s� pagi�a� st ounn aa�foiduza auzi�-iin� auo �s�ai �� an�u o� paamba.z a.z� s�uauzusilq��sa a�tn.�as poo3 ii� �SNOI�LF��I,�I.L2I�� - S2I�IJF�N�'Y�i NOIZ��,L02Id QOOd � , � •t' '" -� £ �'�--,���',�'��a ��v�7!o I�, '�A9 •Z S. � .i ' ,�''�C^ ' .�—� �r� ssauisnq�o aa�id ano�f;�ai� � ui�;ut�m pu� saidoa ,�au apinoad '�sniu no� •spao�aa �s.��a� ;s�d asn ;ou iiin� .�uaut��da �a a Q Q�I H qZ '�o� st� o� suoi����i�a� aa�iojduza �o saido� u���� pu�nnoiaq saa�ioiduza asa� �sii as�ajd •(�d�) uot���t�snsa��uouzindoip.i�� �Turtmuzo� pu� pt�'�sat3 pxepu��s `�faa��s aa��nn�is�q ui pa�i�a��il�uaun�saa�oiduza om��o umu.iiuiuz��sii�snuz sao���ado iood ' � - — — .._ - � - - ____ _ - _ -. V �o 'i - ; a��u�isa a I Id ' I � �S q p 'uuo�siu�o�uoO i�a a� a p���do��u����pue (s)ao��aadp Iood P p u��st as�a n�� a � �f a.�rnbaa s�'ao �aad� oo �s� ai i a�aq;snw.�osin.iadns iood a q,j, �SNOIZ��I3I.L2I�� 'IOOd h� �-�L ��s :#''I�,L :SS�2IQQ�'IJI�II'II�'L�i S�" 71 a�..0 ��L�I�'N S 2I���'NVY�i ��s`� ��-� � �2�11��'�.7,°7" ��g'Ig��I'IddF��I) �Y�IF�N NOI.L�'2IOd2I0� � � ��L�iFJN 2I�NtY10 c�vsP-!CL BQSS' �#"I�.L � o -6l•t� ��».«,�� 's a- •SS�QQ�JI�II'IIF�L�I � � Y r �SS�2IQQ�'NUI.L��O'I �� a � J7 a � ,t,r� �QI X�'.L �)�. � ,, J � :gL�i�'N.LI�I�Y�IHSI'IgF�,LS3 � 'ld� ' X� d uoT�e�iidd�.�no�f�o um�aa au�ur�Insa�Iiinn os op o�mli�� r� .� 'ZIOZ SI�aqz a�a � ,���uauzn�op�ssa�au II�u���i�pir�uuo� a�aiduxo� as�aid * ;� �} Zi�Z £ l �3a � � °��' s�TOZ���1�S1�i��I'I 2I0� , 1�IOI,L�',�I'Idd�' _ � � � � '19�� I� ��.� - ii.L'I�'�H.� -O�I2I�'Og H.LIlOi��'!i,�O 1�IA�O.L � � � ; � � ; . . . y. - - . � - . -� «� , ,�� _ . � �. I � -.. .�.�I��fl�Oj �AO� "2�- �� � �� �'h ��~ , ��'I.I.I.L?8�Y�i�'N.LNI?id ��2If1.I.�'l�I1JIS '21 �.1 ��.L�dQ 'N�"Id�.I.IS�v'�2IIIla�2i�b'Y�i SNOI.LVAON�2I '.LN�Y�i��N�Y�iY�iO� O.L ?IOI?Id H.I.'I�'�H 30 Q2IF�0g�H.L�S Q�AO2IddF�QNF� O.L Q�.L2IOd�2I�g.LSf1Y�i`�'�.L� `.LN�L�idIlla� � 11c��N `IJI�II.I.I�II�'d `'a'?) 'IOOd ?IO 'I�ZOY�t `,LN�L�IHSI'Ig�'.I,S� QOOd llNd O.L S1�IOI.L�'AO1�I�2I 'I'IF� f 'Z i OZ `S T 2i�SY�i���Q�g �S)��3 Q�2IIf1�� QNF� �S)I�tOI.L�'�I'Idd�''I�t1c1�N�Q�.L�'IdL�iO� 3H,L N2�11.L�O.L�i,LI'IIgISI�iOdS�2i 2IR0�SI,LI 'i£�aquza�aQ o�i�nu�f uzo.z��jj�nuue unz s�tuuad�3aISOl�t _ , •pa;iqiqo.�d si�uauzusiiq��.sa a�Tn.zas poo�.zo ii�a�e�fa��npo.�d poo��ue�o��jdsip ao`uoi���daad`�u�oo��oop�np " � ��u�oo�xooaino •�j�aH�o preog a�uzo.z�i�no.zdd�.zoud an�t��snuz`(a�inaas ssa.z�renn�aa�renn u�inn�ut��as aoop�no`•a•t)sa���apts�np ' � � �5�3�� �QIS.L110 •�auz uaaq an�u suua�anoq� au�ii�un�iuzzad�assaQ uazoz3 mo�i�o uoi���onaa�o uotsuadsns au�ut �jnsaa ijinn os op o�amire3 •�uauz�.redaQ u�1�aH au� o�pa�iuzqns s}jnsa.z ajdures c��tn�`za��azau��ji�uouz pue�uivado o�.zoiad q�i pa�t�a�a���s��iq pa�sa�aq�snuz s�assap uazo.z3 �S,L2I�SS�Q l�i�Z02I3 •sur.zo,�ala�p�ojunnoQ `�uauz�daQ�j�aH.zapun sn•�uz•u�nouz� �nnnnnn��a�isqann s�unnos au�uzoa�zo`�uaui�.redaQ���aH au���paut��qo i aq ue� suuo� asaqZ •�uana paza��� au� o� aoizd sniou ZL uuo� uot���ildd� a�inzas poo3 �.zoduzas pa.zinbaa au� �uiig �fq �uauz�.redaQ u�j�aH u�nouz.��� au� �t�ou �snux c��nouu����o unno,i, au� utu�tnn s.�a��� ounn auo�u� ��ai�oa�u�x�i�a k •�uivado o�zotad s�i�p (£) aa.zLj� uot��adsui au�ainpau�s o��uau�.redaQ�I�aH � au�����uo�as�aid •�uivado o;aot.�d�uauz�.redaQ i��j�aH au��q pa��adsut aq�snuz s�uaur�sijq��sa a�in.�as poo�iiF� � ��l�iIl�i�d0 �aIA2I�S Q003'I�'I�iOS�'�S , ��IA2I�S QOO� •�utsoj� �o s��p(�)uanas uiu�inn paaano�ao paui�zp aq�snuz jood�utu.�uinns punoa�ut�oop�.no�ang :�uISO'I�'IOOd •�a�azau� �ij.za�z�nb pere `�utuado o� zoi.zd s�f�p (£) aa.zu� �uaui��daQ u�i�aH au� o� pa�iuzqns pu� `q�j pai�t�a� a���s � �q �uno�a��id pa�pu��s pu�uz�o�ijo�j��o� `seuouzopnasd ao�pa�sa�aq�snuz aa��nn auZ :��IZS�1,2i�s�'M rI00d •pauado pu� pa��adsui uaaq s�u jood a�ji�un�a.re iood au�ui�is o�pannoii�ZON a��aldoad:gZON�S�'3'Id'�uivado o�.zoizd s�i�p(£)aa.z�uoT��adsut a�ajnpau�s o��uaui�daQ u�j�aH au�����uo� •�utuado o�zoiad�uauz�.redaQ i�I�aH au��q pa��adsut aa�snuz uos�as au�zo�pasoj�uaaq an�u u��nn sjoodj.zium pu��uip�nn`�LIiLIILLIiMS jj�l:�uil�t�d0'IOOd szooa •�uaisueaZ paaaptsuo� aq�Ij��aua� ji�us `papuaure s� ` IJ�b9 2II�i� 0£8 T�tJb9 '� "I'IJ'Y�i ut paut,�ap s� `ast�xg �i�u�dn��p Luoo��o uot��ajjo� au� o���afqns si ������dn��0 '�uatsu�z�paaaptsuo� aq�ou ji�qs �iun�uijiannp .zo a�uaptsa��s��tun�san���o asn •pot.zad u�uouz(9)xis�u�utu�Tnn s��p(06)�autu u�u�azouz�ou�o a���a.����ue p�`S��p�0£)�u��u�a.z°uz�.ou�o��uedn��o snonui�uo�o�za�a.z�fjj�zaua�jj�us��u�dn�oo�uaisuezZ�a.�aunnasia a�uapTsaz�o a��Td j�di�utad � ure�ureuz �au� ��u� a��z�suouzap o� ajq� aq pu� an�u �snuz s�uedno u �uaiau��s ` •asn ja�ou pue ja�ouz u�inn pa��iooss��jtz�uzo�sn�pue�iixeuip.zo ��u�dn��o uua��ous pu��aoduza�a �o�p �, i aQ Ii�us�i�credn��o�uaisueaZ`asn ja�oH zo ia�oy��o suot���iuxij au��o sasod�nd ao3 :�au�dfl��0 Zl�i�IS1�t�I.L � I S.LI�i�I�iHSI'Ig�ZS��l�iI�QO'I 2i�H,LO Ql�i�' S'I�ZOI�i ---�N /� S�A / �QI�d 3I 1�'I�.L`dRId02Idd� i �I��Ha�S�'�'Id 's�iuuad ano�i�o a�crenssi zo i�nnaua.z o�.zoi.zd pt�d aq�snux suail pue sa����nouz.re��o unnos I Q�H�V.L,LH QN� Q�NJIS ,LIA�QI33`d 'dY�iO� S�2I��I2IOM ?IO �� � Q�Ha�1.L,lF���1�I�2if1Sl�II 30 '.L2I�� � g0 `��l�i�IS Ql�i� Q'3,L�'Id�Oa �g .LSRNI.LIA�'QI33� 1�IOI1.�Sl�i�dI�iOa S�?I��I2i0Ah �Z�1.S Q�H��1.,L�' �H.L •aou�.msuI uot��esuaduzo� �al�i�2IRSI�iI u� P I1 � an� �ou saop �ueduzo� zo uos.zad ��i ssautsnq � a��.zado uoi��ad aj�a�d�ii z�u o s��zaxaom�o a���t.�i�za� u a � uoi��as n � S ZS j�nnaua�.zo a�u�nssi p[ou o�pa.zmbaz nnou si q�nouu���o��.I. u� 9 Q S �SZ � .,. I�tOIs�'2I,LSII�iII�[QV . t '4"��� C�RTIFICATE OF LIABILITY lNSURA G °�'�`"�°°"�"�"' �.�+''� � E 02/73/2013 THI$ CERTIFlCATE IS (S$,11E0 AS A MAT7ER OF MIFQRMATfON pNLY ANC CONFERS NO RIGHTS UPON TFfE CER7IFICATE NOt,DER.TH1S C�RTIF{CATE pOES NQT A�FlRMATNELY OR NEGA'17V�LY AMIIEND, EXTEPID OR ALTER TNE COYERAGE AI�FORD�D BY THE PQI.lC1ES �ELpW. TF[I$ CER7'IFlCAT'E OF INSURANCE bOES NOT CONSTI7UTE A CONT1iACT BETVYEEN THE ISSUTAIG INSUR�F2(3}, AUTHORIZED � REPRESENTRI7VE OR PRODUCER,AND THE CERTIFICAT�HOLPER iMPORYANT: If fhe c6rtificabo holder is a�ADDI170NAL INSUR�D,�6 poticy(i�sj must be 6ndors9d. ff$UBROGATIOtd IS WAIVED,subject eo � the terms aod eondihons o�Fthe policy,c6rtain pplfeies msy requfre an andansoment A statsmerrt oe thib cBrtifieat�do�not eonfer righis bo the certificat9 holder In lieu of suCh�odolsemeirt(s). ' aP�� HART INSURANCE AG�PtCY,INC- ne- Lsura J MuPphy 243 MAIN STREET Rt+oHe , {50$)759-7326, F�Na:50&759-73$6 FO 60X 700 I BUZZARDS BAY,MA 025320700 � � �NSU S AFFORDfNG C01(EEtACsE Ty��C N I wsu�n: a���SPECtALlY lNS OQ049 n�sux�o hish Village Hokfings,1nc. RL M��R�: � � $22 RoGt6 28 . � SOuth Yarmputh,MA 026�4 �'���� � � n+suaex o: fNSURER E- INSNFb2R F: ���G� CER'�IFIGAT�NUMBER: RE1/{S{ON Nl1MBER: T1i18 iS TO C@ FY 7HAT TH6 P4LICIES OF tNSURANCE LI57'EP BELOW HAV£BEEN IS$UED TO TH8 INSURED NAMED ASQVE FpR'CHE P061CY PEFtIOp INDICAi'ED. NOIIMTHST,qNpING ANY REQUIREMEN7,TERM pR COND�'CIOIV OF ANY CONTRqCT OR OTHER QOGUMF.�IT Wli'H RESPEC'�TO WH1CH 7HIS CERTiFICATE MAY BE IS$UED OR pAAY PERTAfl�1,1J�IE{NSURAItlCE AFFbRDED BY TNE POLICIES DESCRiSED'HEI�EIN 1S SUBJEC7 TQ ALL THE T�RMS. ElC�CLUSIONS A1Vp COMOfTIONS OF SUGN POLIGIE$.UMfTS SHOWN MAY FlqVE BEEN REDUCED BY PAID CLAIMS. INSR iypE OF INSUR/WC.E �HR POUCY F,FF PO�IGY EXP PONCY NUM�BeR M ut LIMITS ' GETIERAL.L]ABILd7Y . EACMIOCCURRFJJCE S rAMMERCIAL GENERA�6�q91LTY YiE !11 Eeu 8 CLA4MS-A1A�E OCCUR IaED EkP one raer S PERS4NhL 8 ADV INJURY S dENERALl1GGRE6ATE i GEM AGGREtaaYE Ll4R APPUFS PER; ' PROpUCTS-COMPMP AGG S POUCY R �,pC s nuToreoert.E uua�urr co e� s ANY AuiO Bd�ILY INJUFtY(Pee person) i ��F.P scHEOULeD �0 BODIlY INJURY(Per apqdpnq g WRED AUTOS �OSNOWN�C O DAMA � s S - UM6RELLA LU�f! oCCUR p�gg� FACH OCCURRENCE 5 CWMS-MAnDE �� � ; 1iEG R�'fEMION s /{ WORKERSCOMP�NSATON JOSQ5406�'I a AND EMPLOYtRg�4A911JTY y!µ 06I13/2012 06/13/2Q13 wc 8 Aru. OFF�CER�iMR9`IBE�E%C�TM.UGH�D7 ECUTNE � N f A �.,,. E.L�Fr4f•H ACCIOEM' S 500000 {Mand�tmy ti NFq�! !rYas,deaenpe wa�r E,L OISenSp-Fq�tpLOYEE S 500000 GESCRIP710N OF OPERAY�ONS belOw E.l.DI$BA6E•POl UMIT S 50��0 r eEs�wpnoet oF O�w►nows r�oca,roros r ve►nq„�s fama�Acoito�o�.Iltlalqarol Rad►uln SchadW��M nwta�paoa b�vquNd) --•_� '� Op�rations as p�iformed by Terms&Conditions in the pplicy.IVIote18,Restelurant�cposure '- 822 Rou.te Z8,South Y�rnoufh,Ma, y - MAY 2 31013 . HEALTH L�LpT. C�R7lFlCATE HOLDEl� CANCLLI.A7'ION . TOUVN OF YARMOI)TH HF�ILTH IAISPECTQR SNOULD ANY QF THE ABQYE DESCK!$,ED POLiC1E5 gB CANCEL{,ED 6EFQRE 794G MA1N STREET 7HE ExP1RATlON DA7E THF1iEOp, NOTIGE WILL B� DEI.IVERECS IN S YARMOUTH;MA 02873 ACCORDqNCE YYITIi 7}��POLICY PROYISIONS_ �axed 508-398-0836 auatow�o r�err�sa+rnmre �.. .. ,.. .�o--�- r �� ACQRD 2'5(Z0�10/05} • �7988 20101�kCORD�'ORpCRATION. Al[rigllt5 rgserv�d, 7he ACORp name and lago are r+�gister�d rnarks of 10.CORp _ _ _ _ i