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'ACORD,,, CER7INCATE OF LIABILITY INSURANCE DATE(MMISDM/YY)
07/09/2010
PR04ucER (516)822-6550 F As: (SIO $22-6564 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Prince Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
183 Broadway HOLDER.THIS CERTIFICAALTER THE COVERA139 AFFORD D BY HE POOLDOES NOT �ICCIIES BTENE OW.
OR
Hicksville, NY 11801
i INSURERS AFFORDING COVERAGE NAIC#
INSURE4 Northfork Animal Welfare League xnc INSURERA: Hartford Insurance Co, i
PO BOX 297 'INSURER 0 '
Southhold, NY 11971 INSUReRC- i
INSURER D. i
COVERAGES W.
I INSURER E. -
1 HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
i--AY PERTAIN,THE INSURANCE AFFORDEE E'/THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITION$OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MA/I-AV!_BEEN REDUCED BY PAID CLAIMS ��((pp���,��(pp
IN9R ADD'L _T I DATE MAFFECTIVE GATE 6IMIDCIVYY N'
L.T IN8R1� TYPR OF INSURANOg POUFY NUMBER
LIMITS
GENERAL LIABILITY 1258ARK5422 07 0112010 07/012011 EACH OCCURRENCE S 1,000,00
X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENFF13
PREMISES(EA newreficn) '� 11000,000
CLAIMS MADE X OCCUR I I MED Ew
XP(Any QRgrgon) I$ 10,00
A PERSONAL R ADv INJURY S 1,000,00
GENERAL AGGREGATE is 21000,000
C+EN'L AGCRECrATE LIMIT APPLIES P!}R;I I ,PRODUCTS-COMPIOP AGG 1 S 2,000.00
PX7LICY I EGT IOC - '
C AUTOMOBILE LIABILITY
ANY AUTO I I COMBINED SINGLt LIMIT
j (Ea amiannt) T
ALL OWNED AUTOS 1
BODILY INJURY
SCHEDULED AUTOS (Pet poran) I
HIRED AUTOS
NON-OWNED ALTOS I 2ODI1 Y INJURY 3
(Pa-XrWem)
1 '
PROPERTY UAMAGS
fFaraccdAm) I S
GARAGE UA8imw
ANVAtIYO
AUTO ONLY-EA ACCIDENT $
'
EA ACC S I
OTHFA THAN ,
I AUTOONLY. AGG I S
EXCESS I UMBRELLA LIABILITY I 12SBARKS422- 07/01/x010 07/01/2011 EACH OCCURRENCE $ 11000,00
X Orr-,UR CLAIMS MADE ( AGGREGATE I
A S 1,000,000
DEDUCTIBLE S
X RETENTION 1 10,000 s
WORKERS COMPENSATION I .2
AND EMPLOYERS'LIABILITY TO Y 1 PLI U.
IMI TS FR
ANY rROPRIETORIPARTNERIEXECUTIVE
OFMCCRIMEMRER EXCLUDED � I E L.EAGHACGiOENT $
(MandmiaryIA NH)
If yyes 0sviba U'Idni i E.L OMAME-EA 6MpLOvEEI S
SPECIAL PROVISIONS nnloty '
OTHER ---
21 DISEASE-POLICY LIMIT•$
I$$CRIPTION OF OPERATIONS I LOCATION$J VEHICLES B.YCLU$ION$ADDED BY ENDORSGMENT I SPECIAL PROVISIONS
ertificate Holder as Landlord (If premises (269 Peconic Land, Peconic, NY) is Additional Insured.
:ERTIKICATE HOLDER � CANCELLATION
SHOULD ANY OF THE AGM oeserdBEp POLopr.It CANCELLED BEFORE THE EXPIRATION
DATE T•H EREOF,THE 1$$UING INSURER WALL ENDEAVOR TO MAIL 30 DAYS wR1TTEN
Town of Southhol d NOTICE TO TNG CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO$HALL
Att! Town Clerk IMPOSE NO OBLIOATION OR LIAMLITY Or-ANY KIND UPON THE INSURCA,ITS AGENTS OR
P-o. Bok 1179 : 'A R6SENTATRICS.
Southold, NY 11971 AUTFIOMEDREPRESENTATMB
.Linda Godnick LINDA .C'ci:cfrr 4'4
CORD 26(2069l01) ®1988.2008 ACORD CORPORATION. All rights reaeiived.
1 ho ACORo name And logo oro registered markn of ACORD