Certificate of Liability Insurance
......... II'''''''' a-........ ...T""t.....,...... ................................-
-,--,----
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 polley. 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).
PRODUCER
HUBBINETTE-COWELL ASSOC INC
1003 Park Blvd, #3
Massapequa Park, NY 11762-2777
: (516) 795-1330 FfjE No:(516) 795-5101
info@hubbinette-cowell.com
INSURER(S) AfFORDING COVERAGE
INSURER A: AMERICAN ALTERNATIVE INS. CORP.
NAICI
19720
INSURED
INSURER 8 :
INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
HUGHSONVILLE FIRE DISTRICT
P.O. BOX 545
HUGHSONVILLE, NY 12537
845-403-3439
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 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.
INSR TYPE OF INSURANCE ADD" SueR ';~15~1 .,;Bt~5~1 LIMITS
LTR lMSR '/NO POLICY NUMBER
GENERAL LIABILITY EACH OCCURRENCE $ 1 000.000
-
...!. 5MERCIAL GENERAL LIABILITY D~\?~ . $ 1.000.000
PREMISES tEa occurrencal
- CLAIMS-MADE ~ OCCUR MED EXP (Any one person) $ 10.000
A VFISTR2062288-03 03/01/11 03/01/12 PERSONAl. & AOV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
~'L AGGRnE LIMIT AFlS PER: PRODUCTS - COMPIOP AGO $ 3,000,000
POLICY ~J}f?; LOC $
AUTOMOBILE LIABILITY lEa accident\ I $ 1,000.000
-
ANY AUTO 03/01/11 03/01/12 BODilY INJURY (Per person) $
X ALL OWNED X SCHEDULED VFISTR2062288-03
A AUTOS >-= AUTOS BODilY INJURY (Per accident) $
-
~ HIRED AUTOS X NON-OWNED iPer aCGidentPAMAGE $
>-= AUTOS
$
~ UMBRELLA L1AB ~IOCCUR 03/01/11 03/01/12 EACH OCCURRENCE $ 5,000,000
VFISCU5056222-03 $10,000,000
A EXCESS LIAS CLAIMS-MADE AGGREGATE
OED I I RETENTION $ $
WORKERS COMPENSATION I we STATU- T IOJ~
AND EMPLOYERS' LIABILITY Y/N
ANV PROPRIETOR/PARTNER/EXECUTIVE 0 E.l. EACH ACCIDENT $
OFFICERlMEMBER EXCLUOED? N'A
(Mandatcny in NH) E.l. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE. POLICY LIMIT $
PUBLIC EMPLOYEE VFISTR2062288-03 03/01/11 03/01/12 $700,000 INCLUDING
A FAITHFUL PERFORMANCE
! BLANKET BOND
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atta<:h ACORD 101, AddiUonal Remarks Sdledule.lf more space is required)
PROOF OF INSURANCE
I
CERTIFICATE HOLDER
PROOF OF INSURANCE
CANCELLATION
SHOULD ANY OF THE ABQVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL DELIVERED IN
ACCORDANCE WIT HE POLICY PROVISIONS.
AUTHOR~ REPRES
ACORD25 (2010/05)
It) 1988-2010 ACORD CORPORATION.
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