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Ciiei 13844 MELOS ACOPD:u CERTIFICATE OF LIABILITY INSURANCE 0DATE MiM 2/04/04 Dnr v) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B.K.McCarthy Ins.Agcy.Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody , MA 01960 978 532-5445 INSURERS AFFORDING COVERAGE NAIC# INSURED _ INSURER A. National Grange Mutual Insurance Co. Melos Construction DBA Faustino Melo INSURER B. Liberty Mutual Insurance Company 34 Jennings Circle INSURER C: Peabody,MA 01960 INSURER D' INSURER E. COVERAGES 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 DESCRBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS O'SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER PO LIE Y EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MMIDDIVY DATE MMIDDIYY A GENERAL LIABILITY MPB23862 11/26/03 11/26/04 EACH OCCURRENCE $500000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES E,occurrence) $500 DDD CLAIMS MADE 51 OCCUR MED EXP(Any one person) S10 000 PERSONAL&ADV INJURY $500 OOO GENERAL AGGREGATE S1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S1000000 POLICY PRO- JECT oc A AUTOMOBILE LIABILITY M91-143926 09/21/03 09/21/04 COMBINED SINGLE LIMIT ANY AUTO (Ea accident S ALL OWNED AUTOS BODILY INJURY $100,000 X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $300,000 X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE $100,000 (Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ROO S AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S $ DEDUCTIBLE $ RETENTION $ S B WORKERS COMPENSATION AND WC531S338762013 12/04/03 12/04/04 X we STATITS FIR u- DTH EMPLOYERS'LIABILITY , _ - ANY PROPRIETOWPARTNERIEXECUTIVE E.L.EACH ACCIDENT $100 000 OFFICERIMEMBER EXCLUDED' E.L.DISEASE-EAEMPLOYEE $100000 If yes describe under SPECIAL PROVISIONS below E1.DISEASE-POLICY LIMIT $SOO,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION For Insured's Purposes DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1111 DAYS WRITTEN NOTICE TO THE OERTIFICAT H ILDno MED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION L 11LIANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES V ACORD 25(2001108) 1 of 2 #43984 LEG 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. A statement on this certificate 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 an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. t ACORD 25•S(2001I08) 2 of 2 #43984