HomeMy WebLinkAboutHuman Resource Cntr/CofL MARSH CERTIFICATE OF INSURANCE CERTIF,C^T "UMBE"
NYC-000313358-09
PRODUCER THIS CER'nFICATE lB ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Marsh USA inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
1166 Avenue of Americas PoucY. THIS CERTIFICATE ~OES NOT AMEND, EXTEND OR ALTER THE COVERagE
New York, NY 10036 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
31675 --..-05..06 A AMERICAN HOME ASSURANCE CO.
INSURED COMPANY
MetLife, Inc. B ZURICH NORTH AMERICA iNSURANCE COMPANY
One Madison Avenue
New York,, NY 10010-3690 COMPANY
C ILLtNOIS NATIONAL INS CO
COMPANY
D Al SOUTH INSURANCE CO.
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE iNSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDiTIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF tNSURANCE POLICY NUMBER POUCY EFFECTIVE UMITS
LTR DATE (MM/DD/YY} DATE (MM,"DO/YY)
A GENERA1- EABIUTY TC2JGLSA 107T5973'05 01/01/05 01/01/06 GENERAL AGGREGATE
~- COMMERCIAL GENERAL LIABILITY PRODUCTS- COMPIOP AGG
I CLAIMS MADE [] OCCUR PERSONAL & ADV INJURY
X OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any one fire)
MED EXP (An}~ one person)
AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT
BODILY INJURY
ALL OWNED AUTOS (per person)
SCHEDULED AUTOS
HIRED AUTOB BODILY INJURY
-- (Per acC=dent)
NON-OWNED AUTOS
PROPERTY DAMAGE
GARAGE MAB~MTY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
-- EACH ACCIDENT
-- AGGREGATE $
B Excsss U~UTY ~,UC-3750732-03 D1/01/05 01101106 EACH OCCURRENCE $ 2,000,000
UMBRELLA FORM AGGREGATE $ 2,000,000
$
OTHER THAN UMBRELLA FORM I WC STATU-
A WO/~X-ERBCOMPENBATION~J'ID 5899256 (ADS) 01/01/05 01,'01/06 X I TORYLiMITSI IOEI~'
EMPLOYERS' UAB~ETY
E 5899254 (NY, WI) 01/01/05 01/01/06 EL EACH ACCIDENT $ 1,000,000
C THE PROPRIETOR] ~ ~NCL 5899255 (MI) 11/01/05 01/01/06 EL DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXECUTIVE
A OFFICERS ARE' EXCL 5899257 (MA,RI,WV) 01/01/05 01/01/06 EL DISEASE-EACH EMPLOYEE $ 1,000,000
A On, ER 5899252 (CA) 01/01/05 01/01/06
D 5899253 (GA) 01/01/05 01/01/06
DESCRIPTION OF OPERATIONSA.OCATION,~'VEHIC LE~PEClAL iTEMG
ALL OPERATIONS OF THE INSURED AT THE HUMAN RESOURCE CENTER BUILDING, 750 PACIFIC STREET, MATTITUCK, NY 1'1952.
THE CERTIFICATE HOLDER NAMED BELOW IS INCLUDED AS AN ADDITIONAL INSURED.
CERTIFICATE HOLDER CANCEU..ATION
TOWN OF SOUTHOLD CERTiFiCA~ HOLDER NAMED HEREIN BUT FAILURE TO r~ML ~JCH NOTICE S~:ALL IMPOSE NO O~LIGATION OR
53095 MAIN ROAD
SOUTHOLD, NY 11971 L~AB~uTY~FANYK~NDUP~NTHE~N$URERAFF~RD~NGc~vEr~AGE~T$AGENT~RREPRE~ENTAT~vE~R~dE
MARSH USA INC.
BY: Katherine S. O'Leary ,{/~/~,~',~.
MM1(3/02) VALID AS OF: 12/29/04
ADDITIONAL INFORMATION
PRODUCER
31675--..-05..06
INSURED
Marsh USA Inc.
1166 Avenue of Amedcas
New York, NY 10036
MetLife, Inc.
One Madison Avenue
New York,, NY 10010-3690
DATE (MMIDDffY)
NYC-000313358-09 12/2g/04
COMPANIES N=FORDING COVERAGE
COMPANY
E NATIONAL UNION FIRE INS. CO,
COMPANY
F
COMPANY
G
COMPANY
N
TEXT
CERTIFICATE HOLDER
TOWN OF SOUTHOLD
53095 MAIN ROAD
SOUTHOLD, NY 11971
Pal~e
Katherine S. O'Leary ['~'~",,' ..~. &~.'~