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BP GC Transfer Request - BP-2021-1834 - 123 Haydenville Rd. - DISH BOBDL00161A Insp. Ross, We have been assigned this DISH Wireless site and will need to transfer the existing BP-2021-1834 - 123 Haydenville Rd. - DISH BOBDL00161A to CCI - Shane McGowan CS-069611 . The scope of work has not changed. Could you advise as to the process, fees and any documents needed to transfer the BP? Attached is the original BP, Shanes' CSL, CCI COI and Workmans Comp Affidavit If anything more is needed, let me know and I will get it to you. Regards, Douglas Rife Construction Project Manager drife@cciproducts.com<mailto:rtrotta@cciproducts.com> Mobile: (508)272-1684 www.cciproducts.com<http://www.cciproducts.com> [cid:4861b0c7-4ad4-4998-95f9-f98301ba268c] Communication Component Systems Inc. This e-mail and any files transmitted with it are, unless otherwise marked, the property of Communication Component Systems, Inc., Communication Components Inc. (CCI) or its affiliates. This e-mail is confidential and intended solely for the use of the individual (s) or entity to whom it is addressed. Any other use, retention, dissemination, forwarding, printing, or copying of this e-mail and any files transmitted with it without the written permission of CCI is strictly prohibited. ACORD 0025 2016-03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANYP ROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTHSTATUTE PER LIMITS(MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) POLICY EFF POLICY NUMBERTYPE OF INSURANCELTR INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $ EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION$ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis of New Jersey, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Communication Component Systems, Inc 89 Leuning Street, 2nd Floor South Hackensack, NJ 07606 Communication Component Systems, Inc. 89 Leuning Street South Hackensack, NJ 07606 09/01/2021 1-877-945-7378 1-888-467-2378 certificates@willis.com Hartford Fire Insurance Company 19682 Trumbull Insurance Company Hartford Casualty Insurance Company 27120 29424 New Jersey Manufacturers Insurance Company 12122 W21923765 A 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 10UUNDD2896 09/01/2021 09/01/2022 B 1,000,000 09/01/202209/01/202110UENDD2772 C 10,000,000 10,000 10 RHU DD2933 09/01/2021 09/01/2022 10,000,000 W21562-4-20D 500,000 11/29/2020 11/29/2021 500,000 500,000 A Blkt Bus Personal Prop Special including theft Limit10UUNDD2896 09/01/2021 09/01/2022 Deductible Replacement Cost 222214321529233SR ID: BATCH: $2,500 $17,696,500 Willis Towers Watson Certificate Center Page 1 of 1