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49-020 (3) 7 s d 'ft. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) • 04/29/2011 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 CONSTFIUTE 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 1S 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 Laurence R. Forrest NAMEE: : Forrest Insurance Agency PHONE 413 858 2680 FAX 858 2685 (A/C, No, Ext): (A/C, No): 603 North Main Street ' E ADDRESS: East Longmeadow, Mass. 01028 PRODUCER �e • CUSTOMER 10 A INSURER(S) AFFORDING COVERAGE NAIC X INSURED INSURERAArbella Protection Insurance Company Window World Of Western Massachusetts, Inc. INsuRERsLiberty Mutual Insurance Company 351 Walnut Street Extension INSURER C: Agawam, Mass. 01001 INSURER D: INSURER E: ___ INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED. NOTWITHSTANDING POLICIES OF INSURANCE REQUIREMENT, TERM OR LISTED BELOW ION HAVE ANY CONTRACT OR OR THE OTHER INSURED DOCUMENTD ABOVE ERESPECT THE POLICY WHICH ER 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. INSR AUUL WEIR POLICY NUMBER (M 1 (MMIDDITYYY) LIMITS LTR ` TYPE OF INSURA INSR 1IJOD GENERAL LIABILITY 0 4 /0 9/2011 04/09/2012 EACH OCCURRENCE $1,000,000 A 7500046889 •iv • - ,' $ 100,000 © COMMERCIAL GENERAL LIABILITY 5, OOO MED EXP (Any one Persor.) $ CLAIMS- MADE ][ OCCUR PERSONAL & ADV INJURY s1/000,000 GENERAL AGGREGATE ;2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 . GEN - L AGGREGATE LIMIT APPLIES PER: $ PRO- POLICY i JECT LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILRY (Ea accident) BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED AUTOS PROPERTY DAMAGE $ SCHEDULED AUTOS (Per accident) HIRED AUTOS $ NON -OWNED AUTOS $ EACH OCCURRENCE $ UMBRELLA UAB OCCUR IIIII EXCESS UAB CLAIMS -MADE II DEDUCTIBLE ------,---- - RETENTION $ WC STA U- OTH- O 5/O7/20 10 0 , B WORKERS COMPENSATION WC1 31S 377947 010 , 5/07/2 TORY LIMITS ER $ 100,000 AND EMPLOYERS LJABIUIY Y/N WC131S 377947 011 05/07/201105/07 /2012 E.L. EACH ACCIDENT ANY PROPRIETORIPARTNERIDCECUTME N / A E.L. DISEASE - EA EMPLOYEE $ 100 , 000 OFFICER/MEMBER EXCLUDED? 500 000 I (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below .® DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Addrbonal Remarks Schedule, if more space is required) CANCELLATION CERTIFICATE HOLDER - Window World Of Wesern Massachusets, Inc- ABOVE RIBED POLICIES BE BEFORE 351 Walnut Street Extension TH E SHOULD EXPANY IRATION OF THE DATE T HEREOFDESC, NOTICE WILL BE CANCELLED DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Agawam, Mass. 01001 AUTHORIZED REPRESENTATIVE y 1 ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25 (2009/09)