Certificate of Liability Insurance
ACORD~ CERTIFICATE OF LIABILITY INSURANCE \ DATE (MM/DDNYYY)
~. 03/24/11
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).
PRODUCER 845-454-0800 CONTACT
NAME:
Marshall & Sterling, Inc. 845-485-7804 rllgNJo Ext\: .\ FAX
iAlc Nol:
110 Main Street E.MAIL
poughkeepsie, NY 12601 ADDRESS:
~~~~g~~~ 10 #: N EWHA-9
INSURER(SI AFFORDING COVERAGE NAIC#
INSURED New Hackensack Fire District INSURER A: Graphic Arts Mutual Ins. Co.
New Hackensack Fire Co Inc INSURER B : Utica Mutual Insurance Company 364
217 Myers Corners Rd INSURER C :
Wappingers Falls, NY 12590 INSURER D :
INSURER E :
INSURER F :
U",IU:::i...AY
~
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 I~~~; ~~ 11~~M%1N!v1 II~g~6%1%1 LIMITS
LTR POLICY NUMBER
GENERAL LIABILITY EACH OCCURRENCE $ 1,OOO,OOll
f--
A X COMMERCIAL GENERAL LIABILITY CPP3468499 03/01/11 03/01/12 P~EMISES lEa occurrencel $ 1,OOO,OOll
l CLAIMS.MADE [!] OCCUR MED EXP (Anyone person) $ 5,OOll
X E&O/HOST LIQUOR PERSONAL & ADV INJURY $ 1,OOO,OOll
GENERAL AGGREGATE $ 3,000,00e
n'L AGG~EnE LIMIT APPlS PER: PRODUCTS. COMPIOP AGG $ 3,000,000
POLICY ~~RT LOC Emp Ben. $ 1MIU3MIL
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,OOO,Ooe
- (Ea accident)
A ~ ANY AUTO CPP3468499 03/01/11 03/01/12
BODILY INJURY (Per person) $
- ALL OWNED AUTOS BODILY INJURY (Per accident)
$
- SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per accident) $
f--
NON.OWNED AUTOS $
f---
$
X UMBRELLA L1AB 1K1 OCCUR EACH OCCURRENCE $ 10,000,00ll
-
EXCESS LIAB CLAIMS.MADE AGGREGATE $ 10,000,00(
B CULP3471539 03/01/11 03/01/12
r-- DEDUCTiBLE $
X RETENTION $ 10 000 $
WORKERS COMPENSATION 1 wc STATt, I IOJ~'
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE 0 NIA E.L. EACH ACCIDENT $
OFFiCER/MEMBER EXCLUDED?
(Mandatory in NH) EL. DISEASE. EA EMPLOYEE $
If ~es, describe under
D SCRIPTION OF OPERATIONS below E. L DISEASE. POLICY LIMIT $
A EXCESS CRIME CPP3468499 03/01/11 03/01/12 DIST TRES 2,000,001
DEP TREAS 2,000,001
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER
CANCELLATION
WAPPI-3
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Wappinger ACCORDANCE WITH THE POLICY PROVISIONS.
20 Middlebush Rd
Wappingers Falls, NY 12590 AUTHORIZED REPRESENTATIVE
J~5 tJJ--
I
ACORD 25 (2009/09)
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: CPP 3468499
COMMERCIAL CRIME
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADD SCHEDULE EXCESS LIMIT OF INSURANCE
FOR SPECIFIED EMPLOYEES OR POSITIONS
This endorsement applies to EMPLOYEE DISHONESTY COVERAGE FORM A or PUBLIC EMPLOYEE
DISHONESTY COVERAGE FORM 0 or P.
A. SCHEDULE
Name Schedule Coverage Position Schedule Coverage
No. of Excess Limit
Item Names of Titles of Location of "Eml~g~ees" of Insurance
No. "Employees" POsitions Covered Positions Each "Employee"
Position
DIST TREASURER -:7
2,000,000
SEE 2,000,000 j
DEPUTY TREASURER DECLARATIONS
CO TREASURER 640,000 ./
PRES FIRE CO 640,000 j
CHAIR OF BD FIRE COM 2,000,000 J
B. PROVISIONS
1. The Excess Limit of Insurance shown In the SCHEDULE applies to each "employee" who is named or who
holds a position shown In the SCHEDULE opposite that limit.
2. The Excess Limit of Insurance applies only to that part of any covered loss that Is excess of an amount
equal to the Limit of Insurance shown in the DECLARATIONS as applicable to the COVERAGE FORM you
purchase plus any applicable Deductible Amount.
3. The Excess LImit of Insurance applies only to loss caused by an Identified "employee".
4. If the Excess Limit of Insurance Is scheduled on a position basis, the most we will pay for an "employee"
holdIng more than one position Is the largest Excess LImit of Insurance In effect and applicable to anyone
of those positions at the time of loss.
CR 101501 89