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HomeMy WebLinkAboutCorazzini Cert of L... (2)ACORD CERTIFICATE OF LIABILITY INSURANCE o112~12oos TM .... ,'~ THIS CbKtIPICATE IS ISSUED ASA MATTER OF INFORMATION RODDOER !'4 O.LY A.B CO.FERS .O R,O.TS U.O.T.E CERT'F'CATE ROY H REEVE AGENCY, It , · PO BOX 54, 13400 MAIN R ' - ~ HOLDER· THIS CERTIFICATE DOES NOT AMEND, EXTEND OR · ; * *., ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MA~'ITUCK NY 11952 '!"'. ~" I 2®~ ..SURERS AF~ORD,.G COVERAGE .A.C# INSURER A GENERAL CASUALTY CO. OF WI INSURED CORAZZINI ASPHALT IN( &/Ol~!~[l'~'l~"i~. ,E~[I~S IN( INSURER B' COX LANE PO BOX 1281 t.'.,((~, . · .,: T :INSURER C CUTCHOGUE NY 1~ ~ao ............. GENERAL LIABILITY CCI0395378 02107105 02~07~06 EACH OCCURRENCE )AE~AGE TO RENTED 50,000 I CLAIMS ~ MEO EXP (Any one person~ 5,000 A PERSONAL & ADV INJURY 1,000,000 -- GENERAL AGGREGATE 2,000,000 ~ POLICY I~PRO'JECT [~LOC I-( PROPERTY DAMAGE $ I OCCUR [~ CLAIMS MADE AGGREGATE $ ~fORKER'COMPENSAT1ONAND CWC0395378 02107105 02107106 I,o.Y,,.-r I OT.E. EMPLOYERS' LIABILITY E.L. EACH ACCIDENT S 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED I~Y ENDORSEMENT/SPECIAL PROVISIONS TOWN OF SOUTHOLD INCLUDED AS AN ADDL INSURED ON AUTO AND GENERAL LIABILITY CERTIFICATE HOLDER CANCELlaTION TOWN OF SOUTHOLD 53095 MAIN RD SOUTHOLD NY 11971 At~ntion: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE iSSUING INSURER WILL ENDEAVOR TO MA~L 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO O~LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER I~S AGENTS OR REPRESENTATIVES ~UTHORIZED REPRESENTATIVE ACORD 25 (2001108) Certificate # 5238 © 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 #5238