HomeMy WebLinkAboutCeritificate of Liability Nov. 6. 2019 4: 28PM No. 8432 P. 1
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ACORUa CERTIFICATE OF LIABILITY INSURANCE DATE(MMIeDIYYYY)
.-- =''f' 11/06/2019
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 T}hE 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 ICONTACT
NAME: Elaine Donoghue
McShea Insurance Agency, Inc RONE
rPc.No,Exit: (508)420-9011 FAX _ 508 so-9010
1645 Falmouth Road, Rt 28 BLDG D E-MAILAsian: elfin mcsheainsurance.com -( )
Centerville, MA 02632
IN$IJ RSR(S)AFFORDING COVERAGE NAIC 0
INSURER A: The Hartford Insurance Company 11011Q_____
INSURED INSURERS: NATIONAL GRANGE MUTUAL, . 14788
Captain Parkers Pub, Inc. IN$URERC; The Hartford Insurance Coglpny 22357
688 Route 26 INSURER D;
West Yarmouth, MA 02673 INSURERE: y�
- INSURER F: _ ry-Y---�---�
COVERAGES CERTIFICATE NUMBER: 00000000-218475 REVISION NUMBER; 2
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 ADD(,SUER POLICY EFF POLICY EXP
TR TYPE OF INSURANCE IPSO AND POLICY NUMBER GASEBONYYyt IMMIDDIYYYY1 UNITS _
A X COMMERCIAL GENERALLIABILLTY 088BANX5037 04/05/2019 04/06/2020 EACH OCCURRENCE S 2,000.000
DAMAGE TO REN1113
CLAIMS-MADEOCCUR
PREMISES Ma mammal s 1,000,000
MED EXP(Anv ffaard $ 5,000
—
—
PERSONAL a ADv INJURY s . .2,0001000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 4,000,000
POLICY Ti JEC 0 LOC PRODUCTS-COMP/OP AGG $ 4,000 000
OTHER. _. Liquor Liabil $ 1,000,000
B AUTOMOBILE LIABILITY M1 T2388U 08/07/2019 08/07/2020 COMBINED,SINGLE LIMIT $ 1,000,000
ANY AUTO BODILY INJURY(Par parson) $
— OW'IED SCHEDULED BODILY INJURY Per accident S
AUTOS ONLY AUTOS ( )
HIRED NON-OYUNED PROPERTY DAMAGE s
AUTOS ONLY X AUTOS ONLY (Per accident)
S
A uMBRELLALIAR A( occuR 08SBANX5037 04/05►2019 04/05/2020 EACH OCCURRENCE $ 1,000,000
x ExcESSLis CLAIMS-MADE AGGREGATE s 1,000,000
DED I RETENTION S S
C AND EMPLOYER LIABILm YIN 08WECCM3443 04/01/2019 04/01/2020 sstA UTF .Fa V
AANY FP pRPRIETORRIPART�DTECUTIVE E N!A E.LEACHACCIDENT $ 1,000,000
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
It .RIpT10 dwelNOF Ot er wow^GPERATIONS ew - __ EL.DISEASE-POLICY LIMIT $ 1,000,000
,
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLE$(ACOR0109,Additional Reamrka Schedule,may he attached It morn 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.
Building Department, Board of Health,Liquor
South Yarmouth, MA 02664 AUTHORIZED PRNSRNTATIVE
. I •-10‘44 (ESD)
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Printed by ESD on November 08,2019 at 04:30PM