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WINDOW WOR ' ` � ,. Etd'CgriN MASS INC
ROBERT BUSH `'{{: • '
361 WALNUT S T E�'�'" T� 4'
AGAWAM, MA 010 1''' = ' Undersecretary
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11aSsachUSetIS • Department ur Puiiiii: S ii ci )
< Board or Building Regulations and Standards
Construction Supervisor License
+ License: CS 57011 '
Restricted to 00
ROBERT E BUSHEY JR
127 ROOSEVELT AVE `
FEEDING HILLS, MA 01030
�....G. . -- Expiration: 6/28/2011
( onun issioner Tr#: 1339 i
CERTIFICATE OF LIABILITY INSURANCE 0 ;2010
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 POUCIES
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 pollcy(ies) must be endorsed. If SUBROGATION IS WANED, 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 Laurence R. Forrest
MANE
Forrest Insurance Agency PHONE 413 858 2680 8 58 2685
603 North Main Street EMAIL •
ADORES&
East Longmeadow, Mass. 0102E
CUSTOMER ID&
INSURERS) ARRIRDING COVERAGE i NAICE
INSURED .ArbcaT T a Protection Insurance Company
Window World Of Western Massachusetts, Inc_
LNSURHI B Liberty Mutual Insurance Company
351 Walnut Street Extension INSURER
Agawam, Mass. 01001 INSURER D.
INSURER E:
INSURER
COVERAGES Cixtu•ICATE NUMBER 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 MP,Y 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
LTR TYPE OF INSURANCE I eon WYD POLICY (INMOOIYYYY) (IOtlDDIYYYY) LOWS
A
GENERAL UABIurr 7500046889 04/09/201004/09 12011 EACH° S 1, 000, 000
X COMMERCIAL GENERALUABAITY P (Ea o ace) S. 100,000
cLnonn.wnE ix Imam MEDswooyampewad $ 5, 000
— �PERSONAL &ADV INJURY $1,000,000
TE $2,000,000
GEN'L AGGREGATE LIMITAPPUES PER - PRODUCTS- (=LimpAGG 5 2,000,000
1 �. POLICY• —• JPEC'T [ LOC __.._..� - — S
AUTONOBII.E LIAMUW Ct7AS8@IED $eKYE LIMIT s. .
• (Ea axidenq
ANY AUTO BODI INJURY (Per person) S
ALL OWNED AUTOS BODILY INJURY (Per accident) S
SCHEDULED AUTOS
PROPERTY DAMAGE
HIRED AUTOS (Per
NON-OWNED AUTOS
S
UMBRELLAUAB OCCUR EACH OCCURRENCE S
EXCESS MB i CUWASMA ]E AGGREGATE S
DEDUCTIBLE S
RETENTION 5 _ S
B - WORKERS COMPENSATION WC3372193 105/07/201005/07 /2011 TOWCS I I°f3i T
AID EMPLOYERS i.lAB0.tiY.
RY FIM[
ANY.PROPRIETtIEP� U- , EL EACH Acc DERE - s 100,000
OFF EXCLUDED'? I NIA
Mandatory in NN) —! EJ., nisa - FAaipLoYER $ 100,000
If yes, desaele ceder
DESCRIPTION OF OPERATIONS below ELDISEASE-POLICY LEST S 500 000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLE S (Attach ACORD 101, AddilianaIRemats Sehedde, il,eore space is mg tiled)
CERTIFICATE HOLDER CANCELLATION
Window World Of Western Massachusetts, Inc.
SHOULD ANY OF THE ABOVE DEWNMBED POLICIES BE CANCELLED BEFORE
351 Walnut Street Exte ^sion THE 177(PRZATIOlf DATE THEREOF, NOTICE W LL BE DELIVERED - IN
Agawam,. Mass_ 01001:
- - - ACCORDANCE WITH THE POLICY PRO7ISIONS_
_ _ AUTHORIZED R ITATNE
•
avitu .
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@ 7988 -2009 ACORD CORPORATION. Al rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered narks of ACORD