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HomeMy WebLinkAboutBldci-16-003273-03 (2) , �....411 DAVEREA-01 NCANUSO AiRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 02/11/2019 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(ies)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). CONTACT PRODUCER NAME: Valley Forge Captive Advisors PHONE (A/C,No,Eat):(610)458-3659 FAX (A/c,No):(484)965-9627 630 Freedom Business Center DriveSuite 203 E-MAILMAILADDRESS: King Of Prussia,PA 19406 I INSURER(S)AFFORDING COVERAGE NAIC S `INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B: Thirwood Place L.P I INSURER C: c/o Davenport Realty Trust 20 North Main Street I INSURER D: South Yarmouth,MA 02664 I INSURER E: I 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 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. IN SR ADDLISUBRI POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE NSD;WVD! POLICY NUMBER (MM/DD/YY1'Yl IMM/DD/YYYY) A I X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE S 1,000,000 I CLAIMS-MADE I X TORETED 1,000,000 OCCUR PREMISES GL08196255 03/01/2019 03/01/2020 DAMAGEES(Ea occurrence) S MED EXP(Any one person) $ 1,000 PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' I GENERAL AGGREGATE S 2,000,000 X POLICY I PRO- LOC I I PRODUCTS-COMP/OP AGG S 2,000,000 ' S OTHER: COMBINED SINGLE LIMIT I 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) S X ANY AUTO ' BAP8196256 03/01/2019 03/01/2020 BODILY INJURY(Per person) ,S OWNED SCHEDULED AUTOS ONLY AUTOS I BODILY INJURY(Per accident) S p HIRED NON-AWNED PROPERTYeaccident)AMAGE S I AUTOS ONLY AUTOS ONLY I I 1 $ UMBRELLA LIAB OCCUR I EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS 1 S IPER A WORKERS COMPENSATION I I X STATUTE I EERH AND EMPLOYERS'LIABILITY YIN WC8196035 03/01/2019 03/01/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE 1 N/A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1 i I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE -47/40 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD '. - 4 °� TOWN OF YA R M O U T H BUILDING ICAL - • GAS C 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING 4 Telephone(508) 398-2231,Ext.I261 —Fax(508) 398-0836 r a SIGNS . BUILDING DEPARTMENT • Inspection and License Report Date // G--79. . Add= C2 37 /Y 71I rho ill sr Business Name ';k ) C /,s.CE' ys Conran Phone During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: / I $ ; / iPaergency egress signage �•i/ /��1JCI — ', . , 9 / / -1- ❑Emergeng egress lighting Location ❑Maintenance of exits Location v ��/7� 2 1Ct'1 / //r p 1-�= /---/,y-..,. •-___ �` ❑Guards/handrails Location ❑signs Location ❑Parking Location ❑ Other Location Merhanicd tj Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location • ❑Automatic door closures on boiler room doors Location - ❑Clothes dryer vents Location f2ther Location • The State Building Code,Section 1001.3t-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. In order to abate the above violation(s)you must: o Make corrections immediately and contact this office for a follow-up inspection. • o Make corrections prior to opening and contact this office for a follow-up inspection. o Make corrections prior to your next annual inspection. o Make corrections within days and contact this office for a follow-up inspection. Local r (:) _TAi k 17 Received By Title i' Revised 2/8/13