35-007 (23) BERKSHIRE INS Fax:14135684284 J u 6 2014 17:06 P. 01 J,5-
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AC
_4—"RO CERTIFICATE OF LIABILITY INSURANCE DATE(p}M/DDPIYYY)
6/6/ap14
THIS CERTIFICATE IS 155UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATNELY 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT, If the certificate holder Is an ADDITIO RED,the 13011cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject fo
the terms and conditions of the policy,certain pollcl endorsement. A statement on this certificate does not confer rights to the
eertlfloate holder In Ilea of such endorsement(s).
PRODUCER OATACT Laura Kis86ri
Berkshire Insurance Group, Trio. Q P ONE. (413)562-3659 FAX
Q tai�ISee-ease
31 Court St. tp .lmisseri Bberkshireinsurancegroup.cco
v O
t� C7 v'
INSURERS 3 gFFORDING COVERA#�E NMC 1:
Westfield MA 01085 41 T INSURERA;ACE American Insurance
INSURED ti INSURER 8:
Fluor 1T LLG, UBA: Jim's Vari v�
} � INSURER C:
15 West Farms Rd L INSURER ft!
INSURER E:
NOrthamton PEA 01062
COVERAGES CERTIFICATE NUMBS 1 6634378 REVISION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED_ NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREtN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSft ADDL SUOR P NUMBER PMND EFF P
LTR TYPE OR lN$U
OLIC EXP LIMITS
RANCE
GENERAL LIA131UTY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGES Ea $
CLAIMS-MADE OCCUR MED EXF(Any one e!w $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $
POLICY PRO LOG $
AUTOMOOILE LIABILITY COMBINED$ MIT
ANYAUTO BODILY INJURY(Per person) $
ALL OWNED F__1
AUTOS AUTOSULED BODILY INJURY(Per scaderd) $
NON-OWNED PROPERTY DAMA E $
HIRED AUTOS AUTOS accide
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEb RETENTION $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIAINLnY YIN It
ANY PROPRIErORfPARTNERIEXECUTIVE❑ NIA E.L.EACH ACCIDENT $
(Ma dEawry In NH)EXCLUDED? E.L.DISEASE-EA EMPLOYE $
If describe under
DESCRIPTION OF OPERATIONS below $J..DISEASE-POLICY LIMIT $
A UST Pollution 024790344001 6/6/2011 6/6/2015 Limlt6erTank $1,000,000
T*01 Aggr4g2t0 Limit $2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.,IF more space 1s requlred
,evidence of UST Pollution Liability. Any exiating event xe exoluded. $5,000 deductible applies
CERTIFICATE HOLDER CANCELLATION
(413)587-1272 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Commissioner ACCORDANCE WITH THE POLICY PROVISIONS.
Louis Hasbrouck
City Of Nort;haawtots AUTHORIZED REPRESENT r
DZorthampto>z, MA 01060
Tebaldi, Darlene
ACORD 25(2010/05) 0 1988-2010 ACORD CORPORATION. All rights reserved.
INS026(2oloo5).ot The ACORD name and logo are registered marks of ACORD