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From:Dan Hu11ey Insurance To:PNI Gouuule Construction %e Date:11/15/2004 Time:10:30:20 AM Page 2 of 3
CERTIFICATE OF LIABILITY INSURANCE Op ID OATS(MM15/0 )
DffiQON-1 li 15 04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dan Hurley Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Chestnut Green, Suite 24 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Seven Federal Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Danvers MA 01923-3620
Phone:978-777-9394 rax:979-777-3306 INSURERS AFFORDING COVERAGE NAIC0
INSURED INSURERA'. Preferred Mutual 15024
INSURER B: Arbeila Protection
AT V4.nout'9 t M Man inc INSt1RER C: Travelers
AT Highland
Avenue
32 Haghlaad Avenue INsuRERD
Saugus MA 01906
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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE MMmDIYY DATE MMIDO UNITS
GENERAL LIABILITY EACH OCCURRENCE $500000
A X COMMERCIALGENERALUABRRY CPP0110569351 09/02/04 08/02/05 PREMISES Ea accuwme 11300000
CLAIMS MADE XX OCCUR MEO EXP(nnr one Persanl $5000
PERSONAL&ADV INJURY $500000
GENERAL AGGREGATE $1000000
GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGO $1000000
X I POLICY PcRcOT LOC
AUTOMOBILE UAB4trY COMBINED SINGLE LIMIT $500000
IS ANY AUTO 21650400002 08/02/04 09/02/05 (Ea acdderk)
X ALL OWNED AUTOS
BODILY INJURY $
X SO4EDI1LE0 P11T05 IPar Parson)
X HIREDAUTOS BODILY INJURY
X NONOVVNEDAUTOS (Peraccidenl) $
PROPERTY DAMAGE $
(Per Raided)
GARAGE LIABILITY AUTO ONLY-EAACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY'. A6G S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND TORYLIMITS ER
C EMPLOYERS'LIABILITY 6XVB0422B24 9 04 01/17/04 01/17/05 EL.EACH ACCIDENT $100000
ANY PROPRIETORIPARTNER/EIECUTIVE
OFFICEWMEMBER EXCLUDED? SEES ATTACHED NOTE E.L.DISEASE-EA EMPLOYE $100000
If as,IW=be Miler
SPECIAL PROVISIONS WIM E.L.DISEASE-POLICY LIMIT $500000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
As per policies.
CERTIFICATE HOLDER CANCELLATION
0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAR 10 DAYS WRITTEN
NOTICE TO THE CERTSCATE HOLDER NAMED TO THE LEFT,BUT FAILURE M DO SO SHALL
Phil Gousoule Construction IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
15 Evans Road REPRESENTATIVES.
Marblehead MA 01945 AUTHORDED REPRESENTATIVE
Daniel J Hurley
ACORD 25(2001109) 0ACORD CORPORATION 1988