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ACORI!®
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(les) 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
McShea Insurance Agency, Inc
1645 Falmouth Road, Rt 28 BLDG D
Centerville, MA 02632
CONTACT
NAME: Elaine Donoghue
PHONE (508)420-9011 FAX Na :ll: (508)420-9010
ADDRESS: elaine@mcsheainsurance.com
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: The Hartford Insurance Company 11000
INSURED
Captain Parkers Pub, Inc.
688 Route 28INSURER
West Yarmouth, MA 02673
INSURER B: NATIONAL GRANGE MUTUAL 14788
C: The Hartford Insurance Company 22357
-INSURER
D:
INSURER E:
.INSURER F:
COVERAGES CERTIFICATE NUMBER: 00000000-22028 REVISION NUMBER: 1
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.
ILFF
TR
TYPE OF INSURANCE
INSD
WVD SUER
POLICY NUMBER
MMIDD/YPOLICY EYYY)
POLICY EXP
(MMIDDNYYYI
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I—XI OCCUR
08SBANX5037
04/05/2018
04/05/2019
EACH OCCURRENCE $ 2,000,000
DA AGE
PREM SESOEa occurrDceen$ 1 000 000
MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ JET F-1 LOC
OTHER:
GENERAL AGGREGATE $ 4,000,000
PRODUCTS -COMP/OPAGG $ 4,000,000
Liquor Liab. $ 100,000
B
AUTOMOBILE
LIABILITY
ANYAUTO
OWNED SCHEDULED
AUTOSONLY X AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
M1T2388U
08/07/2018
08/07/2018
EOaBdent81NGLELIMIT $ 1 000 000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
A
X
UMBRELLA LIAB
EXCESS LIAB
HOCCUR
CLAIMS -MADE
08SBANX5037
04/05/2018
04/05/2019
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDE[
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N I A
08WECCM3443-
04/01/2018
04/01/2019
STATUTE ETH
_
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE- EA EMPLOYE $ 1,000,000
E.L. DISEASE- POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
k•CR I IrlwA i C r1VLUCK
BOARD OF HEALTH
TOWN OF YARMOUTH
Yarmouth, MA 02664
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 -
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Printed by ESD on November 29, 2018 at 01:54PM