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HomeMy WebLinkAbouthigh fac contr a-20150709160509.pdf / , ® DATE(MM/DDIYYYY) A CERTIFICATE OF LIABILITY INSURANCE 4/13/2011 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 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). ACT PRODUCER - NAME: First- Niagara Risk Management- PHONE (315)461-1282 FAX (315)451-3009 First Niagara Risk Management, Inc AIc d Ext: A/C No: E-MAIL - 126 North Salina Street ADDRESS: PRODUCER Suite 400 CUSTOMER ID#P0021396 Syracuse NY 13 2 02-1836 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A:Harle sviIle Insurance Company 33235 INSURER B:Harle sville Worcester 26182 Daniel J. D'Amico Plumbing & Heating Co. Inc. INSURER'c:Wesco Insurance Company 25011 68 Middle Street INSURERD: INSURER E: Geneva NY 14456 INSURER F: COVERAGES CERTIFICATE NUMBER:10-11 R Master 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 CLAIMS. IN SR ADDL SUBR'- - - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 :DAMAGE TO RENTED - lOO,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE LZ OCCUR MPA 82335H 1/21/2011 1/21/2012 MED EXP(Any one person) $ 10,000 X Completed Operations - PERSONAL&ADV INJURY $ 1,000,000 X Contractual Liability GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER - - PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY X PRO- LOC $ JECT AUTOMOBILE.LIABILITY -COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) - ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED AUTOS A 82135H 1/21/2011. 1/21/.2012 - BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE. $ (Per accident). -X 'HIRED AUTOS - X NON-OWNED AUTOS Undennsured motorist - $ PIP Basic $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 8,000,000 EXCESS LIAB CLAIMS MADE'', AGGREGATE. $ 8,000,000 $ DEDUCTIBLE B X RETENTION $ 10,000 CMB 85724H /21/2011' 1/21/2012 $ C WORKERS COMPENSATION X.; WC STATU O R AND EMPLOYERS'LIABILITY T RY L M- YIN E.L.EACH ACCIDENT $ lOD 000 ANY PROPRIETORlPARTNER/EXECUTIVE N/A (Mandatory ER EXCLUDED? �. C3020142 - 1/21/2011. 1/21/2012 E.LDISEASE-EAEMPLOYE $ 100,000 (Mandatory in NH) -If yes,describe under E..L.DISEASE-POLICY LIMIT $ 5.00 000 DESCRIPTION OF OPERATIONS below A Blanket Installation 82335H /21/201111/21/20121 Any OneJobsite $150,000 Floater Special Form rA ,000 Deductible L In Transit Limit $25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Project: Proposed Highway Garage. The Town of Enfield is an additional insured under the General Liability policy on a primary and non-contributory basis, including completed operations, in regard,to work performed by the insured for Town of Enfield, when required by executed written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Enfield 168 Enfield Main Rd Ithaca, NY 14850 AUTHORIZED REPRESENTATIVE Joseph Teresi/PLEWIS -19 .� f ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD ACC INSURANCE BINDER °ATE`MMD°'YYYY' 4/13/2011 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON REVERSE SIDE OF THIS FORM AGENCY COMPANY BINDER#.. Harleysville Insurance First Niagara Risk Management, Inc �B1141391697 126 North Salina Street EFFECTIVE EXPIRATION DATE TIME DATE. TIME Suite 400 X AM X 12-01AM Syracuse NY 13202-1836 4/13/2011 12:01 PM 4/13/2012 NOON PHONE C.N Ext. (315)4 61-12 82 NC No): (315)451-3 0 09 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: SUB CODE: PER EXPIRING POLICY#: AGENCY DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY(Including Location) CUSTOMER ID: 00021396 INSURED Contractor: Daniel J. D'Amico Plumbing & Heating Co. Town of Enfield Inc. 68 Middle St. Geneva, NY 14456 168 Enfield Main Rd Project: Town of EnfieldProposed Highway Garage HVAG Project 475 Enfield Main Rd. State Rt 327 Ithaca NY 14456 Ithaca, NY 14850 COVERAGES LIMITS TYPE OF INSURANCE COVERAGEIFORMS DEDUCTIBLE COINS% AMOUNT PROPERTY CAUSES OF LOSS BASIC BROAD SPEC GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO $ COMMERCIAL GENERAL LIABILITY RENTED PREMISES CLAIMS MADE ❑X OCCUR MED EXP(Any oneperson) $ X Owners & Contractors PERSONAL&ADVINJURY $ Protective Liability GENERAL AGGREGATE $ 11000,000 RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMP/OP AGG VEHICLE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS - PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS $ NON-OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST VEHICLE PHYSICAL DAMAGE DED ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION: STATED AMOUNT OTHER THAN COL GA:AGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY $ EACH ACCIDENT AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF INSURED RETENTION WC STATUTORY LIMITS WORKER'S COMPENSATION EL EACH ACCIDENTAND $ EMPLOYER'S LIABILITY E.L DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT FEES SPECIAL - - CONDITIONS/ TAXES $ OTHER COVERAGES ESTIMATED TOTAL PREMIUM $ NAME&ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE - LOAN# AUTHORIZED REPRESENTATIVE Joseph Teresi/BBULLO ACORD 75(2007/01) Page 1 of 2 ©ACORD CORPORATION 1993-2007. All rights reserved. INS075(200701)a The ACORD name and logo are registered marks of ACORD CONDITIONS This Company binds the kind(s) of insurance stipulated on page 1. The Insurance is subject to the terms, conditions and limitations of the policy(ies)in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of the form is changed from"Insurance Binder"to"Cover Note Applicable in Colorado- With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home' owners, the insurer has thirty (30) business days, commencing from the effective date of coverage,to evaluate the issuance of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company. Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. Applicable in the Virgin Islands This binder is effective for only ninety(90) days. Within thirty(30) days of receipt of this binder, you should request an insurance policy or certificate(if applicable)from your agent and/or insurance company. ACORD 75(2007/01) Page 2 of 2 INS075(200701)a