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HomeMy WebLinkAbout2014 Certificates of Liability CERTIFICATE OF LIABILITY INSURANCE pA'E IMMtpp14 F01/08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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), AUTHORIZED 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 endorsement(s). PRODUCER Phone'. (631) 298-4700 Fax'. (631) 298-3850 CONTACT Barbara Dammers NAME: ROY H REEVE AGENCY, INC. PHONE FAx (631) 298-3850 PO BOX 54 ac Nn E.f: 631 298-4700 ac Nn. E-MAIL bdammers@royreeve.com 13400 MAIN ROAD ADDRESS: MATTITU CK NY 11952 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA US Specialty Ins. Co. INSURED TOWN OF SOUTHOLD INSURERS US Specialty Ins. Co. C/O SOUTHOLD TOWN HALL INSURERC P.O. BOX 1179 INSURER D: SOUTHOLD NY 11971 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 51233 REVISION NUMBER: 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADVL BUBB POLICY EFF POLICY UP LIMBS LTR INSR ME POLICY NUMBER MM/DDMNY MM/DDMNV A GENERAL LIABILITY X CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO(Ee NTEDnre) $ 1,000,000 CLAIMS -MADE OCCUR MED. EXP(Anyone person) $ 10,000 X Detluclible-$50,000. PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OPAGG $ 3,000,000 POLICY P ECT RO LOC EMPLOYEE BENEFITS IT $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accitleirt) $ ANY AUTO BOD I LV INJ URV(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NONOWNED PROPERTY DAMAGE $ AUTOS (Per eooiden[) B UMBRELLA LIAB OCCUR CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 OED X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATLL OTH AND EMPLOYERS' LIABILITY TORY LIMBS ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA EL. DISEASEEA EMPLOYEE $ (Mantlatory in NH) If yes, describe under EL DISEASEPOLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is listed as adiitional insured with respect to general liability as per the terms and conditions of form #PKGLI0040, Blanket Additional Insured, as required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mattituck-Cutchogue UFSD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Superintendent James McKenna ACCORDANCE WITH THE POLICY PROVISIONS. 385 Depot Lane AUTHORIZED REPRESENTATIVE Cutchogue NY 11935 Attention: Thomas A. Dickerson ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE pA'E IMMtpp14 F01/08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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), AUTHORIZED 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 endorsement(s). PRODUCER Phone'. (631) 298-4700 Fax'. (631) 298-3850 CONTACT Barbara Dammers NAME: ROY H REEVE AGENCY, INC. PHONE FAx (631) 298-3850 PO BOX 54 ac Nn E.f: 631 298-4700 ac Nn. E-MAIL bdammers@royreeve.com 13400 MAIN ROAD ADDRESS: MATTITU CK NY 11952 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA US Specialty Ins. Co. INSURED TOWN OF SOUTHOLD INSURERS US Specialty Ins. Co. C/O SOUTHOLD TOWN HALL INSURERC P.O. BOX 1179 INSURER D: SOUTHOLD NY 11971 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 51234 REVISION NUMBER: 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADVL BUBB POLICY EFF POLICY UP LIMBS LTR INSR ME POLICY NUMBER MM/DDMNY MM/DDMNV A GENERAL LIABILITY X CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO(Ee NTEDnre) $ 1,000,000 CLAIMS -MADE OCCUR MED. EXP(Anyone person) $ 10,000 X Detluclible-$50,000. PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OPAGG $ 3,000,000 POLICY P ECT RO LOC EMPLOYEE BENEFITS IT $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accitleirt) $ ANY AUTO BOD I LV INJ URV(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NONOWNED PROPERTY DAMAGE $ AUTOS (Per eooiden[) B UMBRELLA LIAB OCCUR CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 OED X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATLL OTH AND EMPLOYERS' LIABILITY TORY LIMBS ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA EL. DISEASEEA EMPLOYEE $ (Mantlatory in NH) If yes, describe under EL DISEASEPOLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is listed as adiitional insured with respect to general liability as per the terms and conditions of form #PKGLI0040, Blanket Additional Insured, as required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold UFSD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Superintendent David Gamberg ACCORDANCE WITH THE POLICY PROVISIONS. Box 470 AUTHORIZED REPRESENTATIVE Southold NY 11971-0470 pl- Attention: Thomas A. Dickerson ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE pA'E IMMtpp14 F01/08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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), AUTHORIZED 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 endorsement(s). PRODUCER Phone'. (631) 298-4700 Fax'. (631) 298-3850 CONTACT Barbara Dammers NAME: ROY H REEVE AGENCY, INC. PHONE FAx (631) 298-3850 PO BOX 54 ac Nn E.f: 631 298-4700 ac Nn. E-MAIL bdammers@royreeve.com 13400 MAIN ROAD ADDRESS: MATTITU CK NY 11952 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA US Specialty Ins. Co. INSURED TOWN OF SOUTHOLD INSURERS US Specialty Ins. Co. C/O SOUTHOLD TOWN HALL INSURERC P.O. BOX 1179 INSURER D: SOUTHOLD NY 11971 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 51235 REVISION NUMBER: 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADVL BUBB POLICY EFF POLICY UP LIMBS LTR INSR ME POLICY NUMBER MM/DDMNY MM/DDMNV A GENERAL LIABILITY X CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO(Ee NTEDnre) $ 1,000,000 CLAIMS -MADE OCCUR MED. EXP(Anyone person) $ 10,000 X Detluclible-$50,000. PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OPAGG $ 3,000,000 POLICY P ECT RO LOC EMPLOYEE BENEFITS IT $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accitleirt) $ ANY AUTO BOD I LV INJ URV(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NONOWNED PROPERTY DAMAGE $ AUTOS (Per eooiden[) B UMBRELLA LIAB OCCUR CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 OED X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATLL OTH AND EMPLOYERS' LIABILITY TORY LIMBS ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA EL. DISEASEEA EMPLOYEE $ (Mantlatory in NH) If yes, describe under EL DISEASEPOLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is listed as adiitional insured with respect to general liability as per the terms and conditions of form #PKGLI0040, Blanket Additional Insured, as required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Greenport UFSD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Superintendent Michael Comanda ACCORDANCE WITH THE POLICY PROVISIONS. 720 Front Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 Attention: Thomas A. Dickerson ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE pA'E IMMtpp14 F01/08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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), AUTHORIZED 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 endorsement(s). PRODUCER Phone'. (631) 298-4700 Fax'. (631) 298-3850 CONTACT Barbara Dammers NAME: ROY H REEVE AGENCY, INC. PHONE FAx (631) 298-3850 PO BOX 54 ac Nn E.f: 631 298-4700 ac Nn. E-MAIL bdammers@royreeve.com 13400 MAIN ROAD ADDRESS: MATTITU CK NY 11952 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA US Specialty Ins. Co. INSURED TOWN OF SOUTHOLD INSURERS US Specialty Ins. Co. C/O SOUTHOLD TOWN HALL INSURERC P.O. BOX 1179 INSURER D: SOUTHOLD NY 11971 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 51236 REVISION NUMBER: 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADVL BUBB POLICY EFF POLICY UP LIMBS LTR INSR ME POLICY NUMBER MM/DDMNY MM/DDMNV A GENERAL LIABILITY X CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO(Ee NTEDnre) $ 1,000,000 CLAIMS -MADE OCCUR MED. EXP(Anyone person) $ 10,000 X Detluclible-$50,000. PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OPAGG $ 3,000,000 POLICY P ECT RO LOC EMPLOYEE BENEFITS IT $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accitleirt) $ ANY AUTO BOD I LV INJ URV(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NONOWNED PROPERTY DAMAGE $ AUTOS (Per eooiden[) B UMBRELLA LIAB OCCUR CPKG80520109 01/01/14 01/01/15 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 OED X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATLL OTH AND EMPLOYERS' LIABILITY TORY LIMBS ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA EL. DISEASEEA EMPLOYEE $ (Mantlatory in NH) If yes, describe under EL DISEASEPOLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is listed as adiitional insured with respect to general liability as per the terms and conditions of form #PKGLI0040, Blanket Additional Insured, as required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Oysterponds UFSD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Superintendent Richard Malone ACCORDANCE WITH THE POLICY PROVISIONS. 23405 Main Road AUTHORIZED REPRESENTATIVE Orient NY 11957 pl- Attention: Thomas A. Dickerson ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD