Liability Insurance~~~~
ACORD"
AVELL-3 OP ID: FD
~,.,....- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
08/15/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C
ERTIFICATE 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
A
(
),
UTHORIZED
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 endorsements .
PRODUCER Phone: 845-471-6200 ACT
A
HICKEY FINN & CO.
INC N
ME
,
15 Davis Ave Fax: 845-471-9174 PHONE Fax
A/C No Ext : A/C, No
Poughkeepsie, NY 12603 I
A
Donna C. Betts DDR
ESS:
INSURERS AFFORDING COVERAGE NAIC #
INSURERA:Selectlve Ins Co of America
~~ 28301
INSURED Avello Brothers Contractors, _
INSURER B :Rochdale Ins CO
Inc
.
60 Fulton Street INSURER C
Poughkeepsie, NY 12601 INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NIIMRFR• o~..,~,.........
- -- - - -- --- - - - - RCYIJ IVIY 19um6Ctt:
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 W
HICH 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
LTR TYPE OF INSURANCE ADDL UB
POLICY NUMBER POLICY EFF
MM/DD/YYYY POLICY EXP
MM/DD/YYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY S 2021458 07/04/2013 07/04/2014 DAMAGE TO RENTED
1
PREMISES Ea occurrence $
00,000
CLAIMS-MADE ~ OCCUR MED EXP (Any one person) $ 5,00
PERSONAL & ADV INJURY 1
000
00
$
,
,
GENERAL AGGREGATE 2
000
00
,
$
,
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO PRODUCTS -COMP/OP AGG $ 2,000,00
POLICY X
LOC $
AUT OMOBILE LIABILITY D
SINGLE LIMIT
e
B 1
000
00
t
E
a
cide $
,
,
A X ANY AUTO S 2021458 07/04/2013 07/04/2014 BODILY INJURY (Per person) $
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
WNE
O
HIRED AUTOS D
AU
TOS PROPERTY DAMAGE $
Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5
000
00
$
,
,
A EXCESS LIAB CLAIMS-MADE S 2021458 07/04/2013 07/04/2014 AGGREGATE $ 5
000
00
DED X RETENTION $ 10000 ,
,
$
WORKERS COMPENSATION
' X WC STATU- OTH-
AND EMPLOYERS
LIABILITY Y / N T RY LIMITS ER
B ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ~
N / A RWC3294681 04/01/2013 04/01/2014 E. L. EACH ACCIDENT $ 1,000,00
(Mandatory in NH)
If yes
describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,00
,
DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,00,00
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
._
_ ..M._....__.._
Certificate holder is listed as additional insured for contract #13-013
_
the Martz Field East Tennis Court Reconstruction Project. ~ ~'
,~,
Town of Wappinger
Town Hall
20 Middlebush Road
Wappingers Falls, NY 12590
w,~~tKK
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
A UT~~H~~ORIrrZED__RE P RES E NTATIV E
~~'~l~~ ~ ~~~~~~
ACORD 25 (2010/05)
~9ss-z010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD