01/06/2020 BOARD OF SELECTMEN Agenda Packet

Home Browse Search

Client#: 27785 SACJE DATE(MMIDDNYYY) A C- ORDTm CERTIFICATE OF LIABILITY INSURANCE 91 13/2019 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kristie NAME: Sullivan Insurance Group, Inc. PHONE o,Ext:508 791-2241 FAX No): 508 797-3689 1 Mercantile Street EMAIL kdo le sullivan rou .com nn ADDRESS: Y U g p Suite 710INSURER($)AFFORDING COVERAGE NAIC# Worcester, MA 01608 INSURER A:Hanover Insurance Company INSURED INSURER B: Sachs Jewelers of Mashpee, Inc. INSURER C: PO Box 401 INSURER D: Mashpee, MA 02649 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 CONTRACTOR 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. LTR TYPE OF INSURANCE INS°`WVp POLICY NUMBER MMIDDYIYYYY MMID�YIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY OHNA764651 10/23/201 10/23/202 EACH OCCURRENCE $2 000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PROW PRODUCTS COMP/OP AGG s4,000,000 POLICY 0 JECT F LQC OTHER: $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 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 A X UMBRELLA LIAB X OCCUR OHNA764651 U 10/23/2018 10/2312019 EACH OCCURRENCE $1 2000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1 000 000 DED RETENTION$ $ A WORKERS COMPENSATION WZNA764650 10/23/2019 10/23/202 STA uTE aRH IPER AND EMPLOYERS'LIABILITY ANY PROP RIETORIPAR NER/EECUTIVE Y I N N 1 A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? [7N (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Miscellaneous Coverage-Worker's Compensation-Pol.#WZNA764650 Form Information Form: 200301 Edt.Date: 04/01/84 Form Description: NOTICE TO EMPLOYEES (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Mashpee Commons 11, LLC c/o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mashpee Commons Ltd. Partnership ACCORDANCE WITH THE POLICY PROVISIONS. Mashpee Commons PO Box 1530 Mashpee, MA 02649 AUTHORIZED REPRESENTATIVE a 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S3827311M382730 KMD