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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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has permission for gas installation . ,... ! ........................................ .�P..1.
in the buildings of ......G:...... U
at �� (..... ..:.................................. . North Andover, Mass.
FeJex->I��'.......... Lic. No.rr31......�-'.,�'.....
.........................................................................
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04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02
ACERTIFICATE OF LIABILITY INSURA 04TE(MIVIf YYYYI
NCE rage o� 08,29/2013
THII CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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 on 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 an this certificate does notconferrights to the
eertiflcote holder in lieu of such endorsement(s).
97111ia of Massachusetts, Inc.
c/o 26 co-AtBlvd.
P. 0. Box 305191
Nashville, TN 37230-5191
R. H. White Concer'6Notion Company, Inc.
41 Cmntrll Street
P. 0. Box 257
Auburn, KA 01501
-MAIL i rAir.-NOS! 900-9C)/-L3IM
.D.DR��s cext;ificateac�willis,com
INSURER($)AFFORDINGCOVERAGE NAIOtr
IN8URERA:The CAArtar Oak rico Sneuranc9 Company 25615-001
INSURERS: TrI%V41*X9 Property Casualty CotgVany of Am 25674-003
INSURERC_National Union Piro Tnsuranco Company o£ 19445-001
INSURER D; Trpveler6 Indamnity Company 25658-DOl
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURI
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER I
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
NSR
TYPE QFIN$URANCE OD su" POLICY EFF POLICYF�(P
NAR wvn POLICY NUMBER .., -g LIC
A GENEAALLIANLITY I I IVTC20C0 977R9948-13 19/1/2013 1.9/1/2014
IMFRCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
Pt
LAGGREGATI- LIMIT APPLIES PER:
POUQY PRG LOC
S AUTOMOBILE LIABILITY
X ANY AUTO
AUTO$ NED SCHEDULED
X HIREDAUTOS X NON -OWNED
AUTOS
X Co Dad X Coll Ded
9900
C UMBRELLA LIAR OCCUR
X EXCESS LIAR CLAIMS -MADE
DED I $ RETENTION$ 10,000
D WORKERSCOMPENSATION
AND EMPLOYERS' LIABILITY YIN
D ANY PROPRIETORIPARTNFRIEXECUTIVEj ; MIA
OFFICERVEMBEREXCLUDED7 U
(Mantlato Wn NN)
I'UttlUKII-II IUN U UPkRATIONS belOW
Lvidonce of Inauxagce
VT.JCAP 977K955A-13 9/1/2013 9/1/2014
BE6766140 19/1/2013 )9/1/2014
VTRRVB 8205A19S-13 9/1/2013 19/'1/2014
9/1/2014
VTC2KuB 8203.A71A-13 9/1/2013
Remarke Sehodoln, It more sp eea
N NUMBER:
:D NAMED ABOVE FOR THE POLICY PERIOD
IOCUMENT WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS
EACMOCCURRENCE $
2,000,000
ppppM rr��E TORENTF,p
PRE 18E(Eeoeeeronc�f 5
..B
300._000
MEDEXP (Any one pamon
10J, 000
PERSONAL&ADV INJURY $
2 0D0'000
GENERAL AGGREGATE 3
4,000,000
PRODUCTS-COMPIOPAGG $
000 000
NN $
nDMBIGEDtSINGLFLIMIT $
2,00o,000
BODILY INJURY(Perpemon) $
BODILY INJURY(Peraccident) $
AMAGE
erOdent $
$
EACHOCCURRENCF. $
S� 000, 000
AOOREGATE L__$'
000, 000
$
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1, 000 000
E.L.DI2EASE-EAEMPI:QYF.E $
F,L,DISEAsr-POUCYLIMIT S
1,000,000
1/000/000
SHOULD ANY OF TWE ABOVE DI=SCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESe NTATNE
u0AAt4197604 Wp3,:1694012 Cort:20267680 ®1988-2010ACORD CORPORATION. All rights
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD