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Home My WebLink About2014 Jan 07 1502:48p North Fork Animal Welfare 631-765-2203 p.1 JUL-17-2014 09:26 Fr•om:PRINCE ASSOC 5168226564 To:631 765 2203 P•2'2 A� p cm-re/17/�014 �`" CERTIFICATE OF LIABILITY INSURANCE 7/17�2o1a 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 poliey(les)mast be endorsed. If SUBROGATION 19 WAIVED,subject to the terms and conditions of the policy.certain policies may quire an endorsement. A statement on thin certificate does not confer rights to the re certificate holder in lieu of such endorsement(*). PR000CER Lind. A3odnick Fzince Associatels Inc. PNDIa . (5161822-6550 AX .1516)022-6564 270 Daffy Avenue t Suite D INBII RER S AFFORDING COV RA E NAIGf Hicksville NY 11801 INSu RA.Hanover Insurance Grow INSURED INSURER F' North Fork Animal Welfare League Inc. INSURERC• PO Sox 297 INSURER O INSURER 5: Southhold NY 11971 INSURE F• COVERAGES CERTIFICATE NUMBER:? of Soutbold REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCiES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED KM..ED ABOVE FOR TKE POLICY PERIOD INDICATED NOTW:THSTAN04NG ANY REOUIREMENT. TERM OR CCNDITION OF ANY CONTRACT OR OTHER DOCUMENT"iTH 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 UAkTS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS TYPE OF IC UNIBE Ip0Ny PN tACUL UN6TS NB OEHERALLIABILITY EACH OCCURRENCE i 1,GOO,OOC X CONAAFRCIAL GENERAL UAISLITY A CLAMS-MADE ®OCCUR RTr959250202 /1/2014 /111015 MEDEKP jAnt woMID" i 10,000 PER SONA:AADV INJJRY S 11000,000 GENERAL AGGREGATE S 2,000,000 GENLAGGREGATE UMITAPPLIES PER PROOUCTS•COrAPIOP AGG S 21 000 10 a D X POLI(,Y PRO. VMBtNED i 1 AUTOV481W UABILrY LIMI ANY AUTOBODILY INJURY(Por Pa,4cA) S ALL OVMEDSCHEDULED BODILY INJURY(Px wxAdem) S AUTOS NON,OMED DAMA S "RED AUT05 AUTOS S X UNIBR*L.LA LIAR X OCCUR EACH OCCURRENCE S 11000,000 A II[XtESSLIAM CLAVAS-MADE AGGREGATE S 1,000,000 DED I I RETENTIONS RY9S4250202 /1/2014 /1/2025 S WORKERS COMPENSATION VJC ATU• O H AND EMPLOYERS'LIAOLITY ANY PROPRIETORM"-NER,EXICUTIYE YE L EACH ACC30ENT W OFFICERMEMOM EXCDEO? ED NIA 1MNnd4 Wry in Nail E L DISEASE-EA EMPLOY i K ort dlegbNe�ndx DESCRIPTION F OPERA NS G41o�r E L DISEASE-POLICY LIMIT 1 6 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES rAIt46h ACORD 101.AddRlcrud RSr u M4 SchaduN,If mora 4p464 N r4401nal Certificate Holder is Additional Snaured as Landlord of promises.-165 Peconic Land, PBCOnic, MY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. Attl Town Clark P.O. Box 1179 AUTNOWZED AEPRESSNTATAI£ Southold, MY 11971 Linda GodAick/DI �G��SCGJCE7r' �C:ca�.�'rsL/� ACORD 25(201W06) 0 1988-2010 ACORD CORPORATION. All rights reserved. INS025 panom)al The ACORD nature and logo are registered marks of ACORD Jan 071502:48p North Fork Animal Welfare 631-765-2203 p.2 New York State Insurance Fund_ Workers'Compensation&Disability BerrefrLs Specialists Since 1914 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 Phone:(888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A 116024590 NORTH FORK ANIMAL W.E:FARE LEAGUE INC PO BOX 297 SOUTHOLD NY 11971 iPOLICYHOLDER � I CERTIFICATE HOLDER NORTH FORK ANIMALTOWN OF SOUTHOLD WELFARE LEAGUE INC ' TOWN HALL MAIN ST PO BOX 297 I SOUTHOLD NY 11971 SOUTHOLD NY 11971 POLICY NUMBER -CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE Z 673 415-6 257023 08/23/2004 TO 06/01/2015 I 41712014^J THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 573 4156 UNTIL 0 610 1120 1 5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OUTSIDE OOF EWHYORK,TE OF TO THEEPOLIOCY POLICYHOLDER'S REGULARXCEPT AS CATED KEW YORKOW, AND, WITH STATE EMPLOYEES PECT ONLY. TO OPERATIONS ON Y. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 0610112015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AL4END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web sate at https:llwww.nysif.comlcerUcertvai.asp or by c0ing(886)875-5790 VALIDATION NUMBER:845985768 OICD57248-21114 U 26.3