HomeMy WebLinkAboutContract #: 1199 - From: 05-20-2019 To: 08-01-2019 - Weston & Sampson Engineers, Inc. - WTP _041i WESTAND-01 O;
ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrrm
5/7/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZE
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 endorse.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement c
this certificate does not confer rights to the certificate holder in lieu of such endorsements .
PRODUCER CONTACT
Ames&Gough PHONE FAX
859 Willard Street A/c,Ne,Ext:(617)328-6555 A/C,Nc:(617)328-6888
Suite 320 E IL ,boston@amesgough.com
Quincy,MA 02169
INSURERS AFFORDING COVERAGE NAIC p
INSURER A:Continental Insurance Company A XV 35289
INSURED INSURER B:National Fire Insurance Company of Hartford A(XV) 20478
Weston&Sampson Engineers,Inc. INSURER C:Nautilus Insurance Company A+ XV 17370
5 Centennial Drive INSURER D:American Casualty Co of Reading, PA A XV 20427
Peabody,MA 01960 INSURER E:Lexington Insurance Company A XV 19437
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 PERIC
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM:
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP innNYYYi LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000
CLAIMS-MADE OCCUR X 6056861029 1/1/2019 1/1/2020 DAMAGE TO RENTED 506
MED EXP(Any oneperson) 15
PERSONAL&ADV INJURY 1,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000
HPOLICY❑X j ❑X LOC PRODUCTS-COMP/OP AGG 2,006
OTHER:
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000
$
X ANY AUTO X 6056860561 1/1/2019 1/1/2020 BODILY INJURY Perperson)
OWNED SCHEDULED
AUTOS ONLY AIJTNOSW Ep BODILY INJURY Per accident
X 2TOS ONLY Ix
AUTOS ONNLY PROa9dent AMAGE
C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 109000
EXCESS LIAB CLAIMS-MADE X FFX2027937-10 1/1/2019 1/1/2020 AGGREGATE S 10,000
DED RETENTION$
D WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTWE YIN 6056861015 1/1I2019 1/1/2020 E.L.EACH ACCIDENT 1,000
QFFKd.ER/MJMBER EXCLUDED? N/A 1 OOO
((Klan story n N ) E.L.DISEASE-EA EMPLOYE $
If s,describe under 1,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
E Professional Liab 031710990 7/3/2018 7/3/2019 Per Claim 3,000
E 031710990 7/3/2018 7/3/2019 Aggregate 3,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule maybe attached If more space is required)
Additional Insured GL Endorsement Form#CN 75079XX 01/16,If applicable.All coverages are in accordance with the policy terms and conditions.
RE: Route 114/Salem Street MassDOT Permit
Town of North Andover,MA., Division of Public Works shall be listed as additional insured with respect to General,Auto and Umbrella Liability where
required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOF
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I
ACCORDANCE WITH THE POLICY PROVISIONS.
Division of Public Works
Att:Jim Stanford
384 Osgood Street AUTHORIZED REPRESENTATIVE
North Andover,MA 01845 ft