HomeMy WebLinkAboutWorkers Comp only A`CO�RO® DATE(MN/DD YYYY)
CERTIFICATE OF LIABILITY INSURANCE 9/22/2022
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
Jennifer McGee
Hylant-Cincinnati PHONE FAX
50 E-Business Way, Ste 420 AMAINo.Elm:513-985-2400 (ac,Nor 513-985-2404
Cincinnati OH 45241 ADDRESS: jennifer.mcgee@hylant.com
INSURER(S)AFFORDING COVERAGE NAIC#
License*23894 INSURER A: Sentry Insurance Company I 24988
INSURED WINWHOL-01 INSURER B:Sentry Casualty Co 28460
Winsupply W Yarmouth MA Co.
586 Higgins Crowell Rd. INSURER C:AXIS Surplus Insurance Company 26620
West Yarmouth, MA 02673 INSURER o
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1070479193 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR '.ADDL;SUBR'I POIJCY EFF ; POLICY EXP
LTR TYPE OF INSURANCE 1 INSD i WVD i POLICY NUMBER ,(MM/DD/YYYY)i(MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY ! 901698105 10/1/2022 10/1/2023 EACH OCCURRENCE $2,000.000
X DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $2.000,000
MED EXP(Any one person) $0
PERSONAL&ADV INJURY $2,000,000
GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000
POLICY PRO- X LOC PRODUCTS-COMP/OPAGG , $2,000,000
OTHER: j $
A AUTOMOBILEUABIUTY 901698103-AOS 10/1/2022 j 10/1/2023 COMBINED SINGLE LIMIT $3 000.000
901698104-MA only 10/1/2022 10/1/2023
(�a accdent) — T-
A X ANY AUTO BODILY INJURY(Per person) $
901698106-VA only 10/1/2022 10/1/2023
OWNED E; SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY i ,AUTOS
NON-OWNED PROPERTY DAMAGE $X AUTOS ONLY ED 1 X AUTOS ONLY _.Pr accident.)
$
C UMBRELLALIABr I.X OCCUR + P-001-000957487-01 1 10/1/2022 10/1/2023 EACH OCCURRENCE $2,000,000
X • EXCESS UAB CLAIMS-MADE AGGREGATE $2,000,000
DED X I RETENTIONS n $
B WORKERS COMPENSATION 901698101-AOS 10/1/2022 10/1/2023 ;X
STATUTE ; ERH
B ,AND EMPLOYERS'LIABILITY Y/N I 901698102-WI only 10/1/2022 ! 10/1/2023
ANYPROPRIETORPARTNERIEXECUTIVE N !NIA �E.LEACH ACCIDENT $1,000,000
OFFICERMEMBEREXCLUDED9 --(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
II yes,describe under
DESCRIPTION OF OPERATIONS below ! i E.L.DISEASE-POLICY LIMIT $1,000,000
i
1
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is reputed)
°CI' n 7 202'
HEATH DEFT,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Yarmouth Health Department ACCORDANCE WITH THE POLICY PROVISIONS.
Hazmat License Renewal
1146 Route 28 AUTHORIZED REPRESENTATIVE
South Yarmouth MA 02664
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