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HomeMy WebLinkAboutTerp/Cert of LiabilityACORD PRODUCER ROY H REEVE AGENCY, INC. PO BOX 54, 13400 MAIN RD. MATrlTUCK NY 11992 TM CERTIFICATE OF LIABILITY INSURANCE / D^ EIM DD IJA. 1009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED TOWN OF SOUTHOLD C/O SOUTHOLD TOWN HALL P.O. BOX 1179 SOUTHOLD NY 11971 INSURERS AFFORDING COVERAGE INSURER A: INSURER B' INSURER C: INSURER D INSDRER E: American Alternative Insurance Co. American Alternative Insurance Company NAIC # COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ~,NY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THiS CERTIFICATE MAY BE ISSUED OR MAy PERTAIN. THE rNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUEJEC)- TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAy HAVE BEEN REDUCED BY PAID CLAIMS TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL DEDUCTIBLE - $50 000. SIR AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS POLICY NUMBER POLICy EFFECTIVE POLICY EXPIRATION LIMITS 01-A2-RL-0000022-00 JAN 1 08 JAN t 06 EACH OCCURRENCE DAMAGE TO RENTED MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS-COMPIOP ~ COMBINED SINGLE LIMIT 1,000,000 300,000 1,000,000 2,000,000 10,000,000 0 $ GARAGELIABILITY ANYAUTO EXCESS I UMBRELLA LIABILITY ~ CLAIMS MADE OCCUR DEDUCTIBLE RETENTION $ ~VORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER: 60A2UBO00087701 JAN 1 05 JAN t 06 10,000 PROPERTY DAMAGE AUTO ONLY-EAACCIDENT OTHER THAN EA ACC AUTO ONLY: AGGREGATE E L. EACH ACCIDENT E L DrSEASE-EA EMPL E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS COMMERCIAL GENERAL LIABILITY POLICY - EACH OCCURRENCE OF $1,000,000. INCLUDES PROPERTY DAMAGE LIABILITY. ADDITIONAL INSURED INCLUDED ON GENERAL LIABILITY POLICY: ALFRED J. TERP - FOR LEASE OF PARKING LOT AT MAIN ROAD, CUTCHOGUE, NY 11935 C=~ i iPICATE HOLDER DR. ALFRED J. TERP & MARIE TERP 15421 PEACH LEAF LANE GAITHERSBURG, MD 20878 Attention: ACORD 25 (2001108) Certificate # 5147 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITFEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANy KIND UPON THE INSURER. IT'S AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATrVE © ACORD CORPORATION 1988 IMPORTANT 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) Certificate #5147