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HomeMy WebLinkAboutWorkers Comp 2026 1 711-e- ACCORL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/16/25 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 Cr Joe DeOlivelra Deollveira Insurance Services Inc (A/C No,ExO: 508.477-3023 FAX No): 508 638 6463 800 Falmouth RD E-MAIL Suite 105-C ADDRESS: service@dinsinc.com • Mashpee,MA 02649 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: The Hartford-08089020 29459 INSURED INSURER B: The Hartford Perry Lima LLC dba INSURER C: Hearth'N Kettle INSURER D: 1196 Main Sty',; South Yarmouth,MA 02664 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 CLAI INSR ADDLSUBR POLICY EFF POLIC ` �•• LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD •.a. LIMITS X COMMERCIAL GENERAL LIABILITY EA'CH,pCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 1 MED EXP(Any one person) $ 5,000 A 08SBABK4XJD 09/17/25 0 /26 PERSONAL 8,ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 GENERAL AGGREGATE $ 1,000,000 POLICY PE� LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE •' GREGATE $ DED RETENTION$ • ` $ WORKERS COMPENSATION ;'- PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A 08WECBK4XWZ 09/17125 09/17/26 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) FAMILY RESTAURANT-GENERAL LIABILITY WITH LIQUOR ON PREMISES LIABILITY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Yarmouth Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 1146 MA-28 South Yarmouth MA 02664 AUTHORIZED REPRESENTATIVE fabinhoperrylima@gmail.com, ©1988-201 CORD CORF@RATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD