HomeMy WebLinkAboutMiscellaneous - 951 FOREST STREET 4/30/2018 (2)b 08/11/2008 09:41 9787443575 GERALD MCCARTHY INS PAGE 01
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Gerald T. McCarthy Insurance Agency, Inc.
P.O. Box 839 - 92 North Street, Salem, MA 01970
978-744-6433 - Fax 978-744-3575
,August 11, 2008
Town of North Andover
951 Forest Street
North Andover, MA
Re: Lawrence Leblanc, Liberty Mutual Pol# WC231S352562017
Dear Sir:
Enclosed please find a certificate of insurance as evidence of liability coverage for the above
mentioned.
By law, certificates for workers' compensation insurance must be issued by the assigned insurance
carrier; therefore, we have Faxed a request to the above mentioned company to issue a worker's
compensation certificate of insurance which they will mail directly to you. In the meantime, please be
advised by us that this coverage is, in fact, presently active for the period of September 28, 2007 to
September 28, 2008
I hope you will find everything in order; and if you have any questions, please feel free to call.
Sincerely,
Deborah Tournas
dt
08/11/2008 09:41 9787443575 GERALD MCCARTHY INS PAGE 02
ACORD �'' CERTIFICATE OF LIABILITY INSURANCE DATE `"""DD"""'
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PRODUCER MCC (97B) Y INSURANCE
FOX:RA CE T44-3575 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
GERALD T MCCARTHY INSURANCE AGENCY, WC ONLY ANP CONFERS NO RIGHTS UPON THE CERTIFICATE
92 NORTH ST HOLDER. THO CERTWEATE D093 NOT AMEND, EXTEND OR
P O BOX ALTER THE
SALEM MAA 01970 COVERAGE AFFORDED By THE POLICIES BELOW.
0
INSURERS AFFORDING COVERAGE NAS M
u. __...__. ..
INSURED iINSURER A: SAFETY NSURANCE COMPANY •
LAWRENCE LEBLANC---.'_........_....., ..._... _. ._.._... �......
P O BOX 5389 ;INSURER e:
HAVERHILL MA 01035 INSURER C:
I INSURER D:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT 014 OTHER DOCUMENT
SHOULD ANY OF THE ABOVE OESCRIBEO POLCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITTEN NOTICE TO THE CERTKICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.
RB AGENTS OR REPRESENTATIVES.
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
PULICIES,
AUTHORIZED REPRESENTATIVE
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS.
SUCH
LTIt ' 4 TYPi OF INSURANCE PDLIDY NUMBER Paley EFFECTIVE POLICY EII►NATgN
LIWTS
GENERAL LIABILITYOPOW3831 00/03/09 08/03/09
C
I EACHOCCURRRNCE i
1,000,
X COMwRCIALGENERALLIABILITY:
:DA"-
GET AE
IINf[0 .1-1"-"
o
"""-"""
CLAIMS MADE X~ OCCUR
PAE aml _ j s
100.000
I
MED. EXP (Any LIN! Person)
�� 000
A
.. _ .._._._....
_ ... —
. PERSONAL A ADV INJURY f
1,0001000
GENERAL AGGREGATE i
:L000,000I
GEN'L AGGREGATE LIMIT APPLIES PER
!PRODIJCTS-00NPIOPAGG, - �_____" ....��
' PRO- •- –
21,
POLICY
IM6T LOCI
_--. —
AUTOMOBILE LIABILITY I
ANY AUTO
COMBINED SINGLE LIMIT
I
(Ea ECCIdeM) f
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per Demon
HIRED AUTOS
NONOWNEDAUTOS
•
BODILY
(Per acctdsnq
fti
_.. ._.._. _...
•Per
PROPERTY DAMAGE i
scadl111
GARAGE LIABILITY
; AUTO ONLY • EA ACCIDENT
ANY AUTO
OTHER THAN PA ACC . f
AUTO ONLY:
AGG i
EXCESS I UMBRELLA LUIaILRY
IEACH OCCURRENCE i
OCCUR ;CLAIMS MAGE
AGGREGATE i
'
DEDUCTIBLE
I
..._ . I .. ......,
..._......___
RETENTION f
I �...._..._..
_.
S
WORKERS COMPENSATION AND
TuMITS OtHER
EMPLOYERS LIAIKITY
ANY PROPRIETOWARTNEIIEXECYTIYE
E.L. EACH ACCIDENT f
EII E1tCL11D0T
_.._.
DISEASE -FA EMPLOYEE 'f
Etopiii.
_.
domed".L.
SPECIAL PIMVIEIONX Pwr
E.L. DLSEASR.POLICY LIMB ti
OTHER:
DESCRIPTION OF OPERATIONS/LOCATIONSNENICLESIEXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
SIDING, GUTTERS, DOWNSPOUTS INSTALLATION
TOWN OF NORTH ANDOVER
931 FORREST STREET
NORTH ANDOVER, MA
SHOULD ANY OF THE ABOVE OESCRIBEO POLCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITTEN NOTICE TO THE CERTKICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.
RB AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Attention.
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A%L.vlsv da Iduavuol LArouc7TB s ani r 0 ACORD CORPORATION 1900