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CERTIFICATE OF LIABILITY INSURANCE 05/19/2023
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 NAME: CLIENT CONTACT CENTER
FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX
HOME OFFICE:P.O.BOX 328 (A/C,No,Eat):888-333-4949 (A/C,No):507-446-4664
OWATONNA,MN 55060 ADDREss:CLIENTCONTACTCENTERaFEDINS.COM
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 172-761-9 INSURER 8:
DRYWALLIMASONRY SUPPLIES,INC. INSURER C:
277 WHITES PATH
SOUTH YARMOUTH,MA 02664-1217 INSURER 0:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:15 REVISION NUMBER:0
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. Pp�C FF pp
ILIA TYPE OF INSURANCE ADDL SUBR POUCY NUMBER ItrINCD,VYYI (MM/DaYYYPYI UMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR ?AVE TO RENTED PREMISES $100,000
lEa ocaRn
MED EXP(Any one person) EXCLUDED
A N N 6076420 07/01/2023 07/01/2024 PERSONAL S ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $2,000,000
X POLICY PRO- LOC JECT PRODUCTS&COMP/OP AGO $2,000,000
OTHER:
AUTOMOBILE LIABIUTY C OMBUINdEaDtSINOLE LIMIT $1,000,000
X ANY AUTO BODILY INJURY(Per Person)
A _OWNED AUTOS ONLY_AUTOS SCHEDULED N N 6076419 07/01/2023 07/01/2024 BODILY INJURY IPar Accident)
_HIRED AUTOS ONLY NON-OWNED JaPar ROPAccidaERTYDAMAGE
AUTOS ONLY n
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $6,000,000
A EXCESSLIAB CLAIMS-MADE N N 6076422 07/01/2023 07/01/2024 AGGREGATE $6,000,000
DED RETENTION
WORKERS COMPENSATION X PER STATUTE OTHER
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE T E.L EACH ACCIDENT $500,000
A OFF10ER/MEMBEREXCLUDED? N/A N 6076423 07/01/2023 07/01/2024
(Mandatory In NH) E.L DISEASE EA EMPLOYEE $500,000
IT yes.describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY UMIT $500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) •'AY 3 0 2023
HEALTH DEpr.
CERTIFICATE HOLDER CANCELLATION
172-761-9 15 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
TOWN OF YARMOUTH BOARD OF HEALTH
1146 ROUTE 28 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
SOUTH YARMOUTH,MA 02664-4463 ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE A
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O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(20113/03) The ACORD name and logo are registered marks of ACORD
172-761-915
#BWNDHBS BJ000-02-0024
#XWXW0021 XXXXXXX5#
TOWN OF YARMOUTH BOARD OF HEALTH
1146 Route 28
South Yarmouth, MA 02664-4463