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ACCORD® DATE(MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 07rz2rz019
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 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
NAME: Cynthia Feeley
DOWLING&O'NEIL INSURANCE AGENCY OkIICN,Ext): (508)775-1620 FAX
(A/C,No):
EMAIL cfeeley@doins.com
ADDRESS: Y@
973IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIL*
HYANNIS MA 02601 INSURER : ACE AMERICAN INSURANCE CO 22667
INSURED INSURER B:
PERRY KENNETH INSURERC:
DBA KP REMODELING&CONSTRUCTION INSURERD:
19 GUILDFORD RD INSURER B:
CENTERVILLE MA 02632 INSURER F:
COVERAGES CERTIFICATE NUMBER: 427625 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 SUER POLICY EFF POLICY EXPM/n (M LIMITS
LTR INSn� POLICY NUMBER MIDDIYYYY) (MMIDDIYYYY)
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMA $
CLAIMS-MADE OCCUR PREMISES(Ea occcurrenE e) $
MED EXP(Any one person) $
N/A PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY I I SCOT LOC PRODUCTS-COMP/OPAGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO —
BODILY INJURY(Per person) $
ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $
NON-OVNJED PROPERTY DAMAGE $
HIRED AUTOS _AUTOS (Peracadent)
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION X STATUTE OTH-
ER
AND EMPLOYERS LIABILITY
ANY CUTIVE
A OFFICERNEMBER EXCLUDED? N/A N/A WA 6S62UB1 K40373019 06/13/2019 06/13/2020 E L.EACH ACCIDENT $ 500,000
(MandatorylnNH) E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
N/A
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to
employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this
certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at
vmw.mass.gov/Iwd/workers-compensationAnvestigations/.
Sole proprietor has not elected coverage.
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.
1146 Route 28
AUTHORIZED REPRESENTATIVE
South Yarmouth MA 02664 1"
Daniel M.Cr o fey,CPCU,Vice President—Residual Market—WCRIBMA
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