Page 48 - Barr&Barr_RiversEdge_10.19.17(Flipbook)

DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 5/27/2016
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).
CONTACT
PRODUCER NAME: Laura Martino
Alliant Insurance Services, Inc. PHONE 516-414-8604 FAX
333 Earle Ovington Blvd. (A/C, No, Ext): (A/C, No):
Uniondale NY 11553 E-MAIL laura.martino@alliant.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :Travelers Property Casualty Co of A 25674
INSURED INSURER B :Travelers Indemnity Company 25658
Barr & Barr, Inc. INSURER C :Charter Oak Fire Insurance Company 25615
460 West 34th Street, 10th Floor INSURER D :American Guarantee and Liability In 26247
New York, NY 10001
INSURER E :National Union Fire Ins Co Pittsbur 19445
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1114333055 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 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY VTRJCO2381A784TIL16 4/1/2016 4/1/2017 EACH OCCURRENCE $2,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $300,000
X Contractual Liab MED EXP (Any one person) $15,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY X PRO- LOC PRODUCTS - COMP/OP AGG $4,000,000
JECT
OTHER: $
B AUTOMOBILE LIABILITY VTKCAP2381A796IND16 4/1/2016 4/1/2017 COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS
(Per accident)
$
A X UMBRELLA LIAB X OCCUR VTSMJCUP4E994578TIL16 4/1/2016 4/1/2017 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
X
DED RETENTION $$10,000 $
C WORKERS COMPENSATION VTROUB2381A77216 4/1/2016 4/1/2017 X PER OTH-
AND EMPLOYERS' LIABILITY Y / N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
D Excess Liability AEC0191657-00 4/1/2016 4/1/2017 $20,000,000 Occ / Agg
E Excess Liability 48402741 4/1/2016 4/1/2017 $25,000,000 Occ / Agg
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SAMPLE CERTIFICATE OF INSURANCE

CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
SAMPLE CERTIFICATE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SAMPLE CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS.
SAMPLE CERTIFICATE NY 11111
AUTHORIZED REPRESENTATIVE

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