CERTIFICATE OF LIABILITY INSURANCE · Logical Environmental Solutions, LLC 354 South River Road...
Transcript of CERTIFICATE OF LIABILITY INSURANCE · Logical Environmental Solutions, LLC 354 South River Road...
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Certificate Holder is named as an Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
Diversified Technology Consultants, Inc. Attn: Donna Balogh 556 Washington Avenue North Haven, CT 06473
(203)234-7376
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Certificate holder is named as Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
GeoInsight, Inc. Attn: Stacy Leach 25 Sundial Avenue Suite 515W Manchester, NH 03103
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
HRP Associates, Inc. is included as Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
HRP Associates, Inc. Attn: Carol Gandarillas 197 Scott Swamp Road Farmington, CT 06032
(860)674-9624
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Lenard Engineering Inc. & Alliance Energy Corporation are named as Additional Insureds for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
Lenard Engineering, Inc. Attn: Mark Temple 1766 Storrs Road P.O. Box 580 Storrs, CT 06268
(860)429-1367
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Lenard Engineering, Inc. is named as Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
Lenard Engineering, Inc. Attn: Mark Temple 1768 Storrs Road P.O. Box 580 Storrs, CT 06268
(860)429-1367
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Proof of Insurance
10
Samuel Worthen/PAT
LFR, Inc. Attention: Sonia 87 Church Street East Hartford, CT 06108
(510)652-2703
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Certificate Holder is named as Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
Maguire Group, Inc. Attn: Reena Sarnie 33 Commercial Street Suite #1 Foxborough, MA 02035
(508)543-5157
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
MBI#10-45-07049/Federal Contract #W91ZRS-07-C-005. Site Remediation at the former Ansonia Armoy Project, Ansonia, CT. Manafort Brothers, Incorporated, City of Ansonia, Maguire Group Inc.(engineer), the State of CT Army National Guard and the Department of the Army - National Guard Bureau, and each of their appointed or elected officers, directors, committeee members, employees, volunteer workers, commissioners, and any affiliated, associated or allied entities and /or bodies thereof are named as Additional Insureds for General Liability as respects the operations of the named
10
Samuel Worthen/PAT
Manafort Brothers, Inc. Attn: Gwen Mills 414 New Britain Avenue P.O. Box 99 Plainville, CT 06062
(860)793-6573
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
COMMENTS/REMARKS
COPYRIGHT 2000, AMS SERVICES INC.OFREMARK
insured. Each policy is primary. Waiver of Subrogation applies for the General Liability policies in favor of the Additional Insured.
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Re: For drilling soil borings in AMTRAK-SEPTA parking lot at Broad & Indiana Avenues in Philadelphia, PA
National Railroad Passenger Corporation is named as an Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
National Railroad Passenger Corporation Attn: Director Project Initiation & Development 30th Street Station Mail Box 64 Philadelphia, PA 19104
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Northeast Utilities and it's subsidiaries are included as additional insureds, as their interests may appear, with respect to general liability for operations performed by or on behalf of the named insured.
10
Samuel Worthen/PAT
Northeast Utilities Attn: Claims & Insurance Department PO BOx 270 Hartford, CT 06141
(860)665-3820
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Re: contract #06PSX0137 State of CT DAS/Procurement services is included as an Additional Insured with respect to General Liability for operations performed by or on behalf of the named insured.
10
Samuel Worthen/PAT
State of CT DAS/Procurement Services 165 Capitol Avenue Hartford, CT 06106
(860)622-2921 [email protected]
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Certificate Holders are Tetra Tech Rizzo and State of CT - Department of Transportation.
10
Samuel Worthen/PAT
Tetra Tech Rizzo 150 Trumbull Street 4th Floor Hartford, CT 06103
(860)549-8422 DavidT.Williams@tetratech.
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Town of West Hartford is named as Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
Town of West Hartford 50 Main Street West Hartford, CT 06107
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).
CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
INSURERS AFFORDING COVERAGE
COVERAGES
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2001/08) © ACORD CORPORATION 1988
DATE (MM/DD/YYYY)
PRODUCER
INSURED
INSR LTR
SCHEDULED AUTOS
TYPE OF INSURANCE POLICY NUMBER
HIRED AUTOS
POLICY EXPIRATIONDATE (MM/DD/YY)
NON-OWNED AUTOS
LIMITS
GENERAL LIABILITY
GARAGE LIABILITY
EXCESS/UMBRELLA LIABILITY
WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
AUTHORIZED REPRESENTATIVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT, 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSURER A:
INSURER B:
INSURER C:
INSURER D:
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
ANY AUTO
EACH OCCURRENCE
COMBINED SINGLE LIMIT (Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE (Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
EA ACC
AGG
EACH OCCURRENCE
AGGREGATE
WC STATU-TORY LIMITS
OTH-ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
INS025 (0108).08a
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICYPRO- JECT LOC
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
Page 1 of 2
NAIC #
POLICY EFFECTIVEDATE (MM/DD/YY)
ADD'L INSRD
DAMAGE TO RENTEDPREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?If yes, describe underSPECIAL PROVISIONS below
$
3/26/2009(860)829-5999 FAX: (860)829-2066
McDonough and Keegan Insurance Agency, Inc.1210 Mill Street
East Berlin CT 06023
Logical Environmental Solutions, LLC354 South River Road
Tolland CT 06084
General Casualty Ins Co 18821Endurance American Spec.
XX
X
2,000,000300,00010,000
2,000,0004,000,0004,000,000
A CCI0611678 4/1/2009 4/1/2010
XXX
1,000,000
A CBA0611677 4/1/2009 4/1/2010
X
X 10,000
1,000,0001,000,000
A CCU0611675 4/1/2009 4/1/2010
A X500,000500,000500,000
CWC0611676 3/22/2009 3/22/2010
B Pollution & ECC10100679400 4/22/2009 4/1/2010 Each Accident $1,000,000Professional General Aggregate $2,000,000Liability Deductible/Retention $5,000
Certificate Holder is named as Additional Insured for General Liability as respects the operations of the named insured.
10
Samuel Worthen/PAT
TRC Environmental Corporation Attn: Doug Martin 21 Griffin Road North Windsor, CT 06095
(860)298-6399
ACORD 25 (2001/08)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuinginsurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negativelyamend, extend or alter the coverage afforded by the policies listed thereon.
Page 2 of 2INS025 (0108).08a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on thiscertificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require anendorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of suchendorsement(s).