HomeMy WebLinkAboutElectrical Inspectors, Inc.ACORD CERTZFZCATE OF LZABTLTTY TNSURANCE I
PRODUCER (631)821-5300 FAX (631)821-1138
The AFl: - KOCH Agency
]:nsurance & Financial Services
151 Route 25-A, P.O. Box 1605
Rocky Point,, NY 11778-1605
inSURED Suffolk Bureau of Electrical Tnspectors, ]:nc
40 Nottingham Drive
Middle ]:sland, NY 11953
THIS CERTIF:~CATE ZS TSSUED AS A MAi i =et OF ZNFORMATTON
ONLY AND CONFERS NO RIGHTS UPON THE CERTTFTCATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURERA: Merchants Mutual Insurance Co,
INSURER B:
INSURER C:
INSURER D:
i I INSURER E:
COVERA~F~
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
[NSR POLICY e~eCT~VE POLICY EXPIRATION
LTR TYPE OF TNSURANCE POLICY HUMBER DATE (MMIDDIYYI DATE (MMIDDIYYI LIMITS
GENERALLIABTLITY :CP8664949 09/28/2002 09/28/2003 EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100 ~ O0~
I CLAIMS MADE ~-] OCCUR MED EXP (Any one person) $ 5,00(]
A PERSONAL & AOV INJURY $ 1,000,00~
i -- GENERAL AGGREGATE $ Z, 000! 00~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
I ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG
EXCESS LIABILITY EACH OCCURRENCE $
I OCCUR 1~ CLAIMS MADE AGGREGATE
$
DEDUCTIBLE $
RETENTION $ $
WC
STATU-
OTH-
WORKERS COMPENSATION AND
TORY LIMITS I
ER
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
E.L DISEASE- ~ EMPLOYEE $
E.L DISEASE - POLICY LIMIT $
OTHER
DESCRZPT~ON OF OPERATZONS/LOCAT[ONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISTONS
CERTIFTCATE HOLDER I I ADDmONAL INSURED; INSURER LETTE
CANCELLAT[ON
Town Of Southold
ACORD 25-S (7/97)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPTRATZON DATE THEREOF~ THE TSSUING COMPANY W~IENDEAVOR TO MATL
30 DAYS WR~TYEN NOT~CE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
BUT FAILURE TO MAIL SUCH NOT,CE SHALL IMPOSE NO OBUGAT~ON OR
OF ~IY KI:ND UPON THE COMPANY, TTS AGENTS OR REPRESENTATIVES.
AUTH61~ZZEDREpRESENTATZV~ £ ~ ~-~ /~ ( / ~?/
ZMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DZSCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract betwee~
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does i'
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed there
ACORD 25-S (7/97)