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HomeMy WebLinkAboutCertificate of Liability Insurance �'1 JAMSHOT-01 JHOGAN '4`c„�RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/2/2019 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). PRODUCER CONTACT Roblin Insurance Agency PHONE FAX 144 Gould Street Suite 100 (NC,No,Ext):(781)455-0700 1(aL,No(781)449-8976 Needham,MA 02494 ADDRESS:certificates@roblininsurance.com / 7 co /`7 2 1e A INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Liberty Mutual Insurance Company 23043 INSURED INSURER B:Liberty Mutual Fire Insurance Co. S&H Hotel Yarmouth LLC INSURER C:Chubb Group of Insurance 41386 Go Jamsan Hotel Management 83 Hartwell Avenue INSURER D:AIM Mutual Insurance Co 33758 Lexington,MA 02421 INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD (MM/DDIYYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR TB2-Z11-261917-018 8/1/2018 11/1/2019 DAMAGETO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20,000,000 X POLICY WI, X LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO AS2-Z11-261917-058 8/1/2018 11/1/2019 BODILYINJURY(Perperson) $ _ AUTOS ONLY X AUTOSULED BODILY INJURY(Per accident)- $ X HIRED X NON WN D PROPERTY pAMAGE AUTOS ONLY AT ONLY (Per accident) $ x Collision X Comprehensive Deductibles $ 500 C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 25,000,000 EXCESS LIAB CLAIMS-MADE 78187751 8/1/2018 11/1/2019 AGGREGATE $ 25,000,000 DED X RETENTION$ 10,000 $D WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER WMZ-800-8006935-2019A 8/1/2019 8/1/2020 E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE / 500,000 wag/mil N N/A (Mandatory m NH) 500,000 E.L.DISEASE-EA EMPLOYEE $ If_yes.describe under DESCRIPTION OF OPERATIONS below T E.L.DISEASE-POLICY LIMIT $ 500,000 A General Liability TO2-Z11-261917-028 8/1/2018 11/1/2019 Liquor Liability 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Named Insured Includes:S&H Hotel Yarmouth,LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE n of YarmouthTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tow Tow Route ACCORDANCE WITH THE POLICY PROVISIONS. 1146South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE -C7.w i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD