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297 Highland Avenue - workers comp 2 BATTE-1 OP ID: SG ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM 12/2912021 YY) 2021 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. 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). PRODUCER 781-431-2500 CONTACT NorthStar Ins.Services,Inc. PHONE FAX 300 First Ave,Suite 100 (A/c,No,Ext):781-431-2500 ac,No):781-431-6134 Needham,MA 02494 E-MAIL ADDRE : INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company 19259 INSURED Batten Brothers,Inc. INSURER B: 893 Main Street Wakefield,MA 01880-3954 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRDD/YY D/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE F_X]OCCUR S 2040359 08/27/2021 08/27/2022 DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ X Contractual Liab SEPARATION OF INSUREDS MED EXP(Any oneperson) 15,000 X XCU Included PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY[X]JECT LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: Emp Ben. $1 m/$3m A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO A 9107471 12/31/2021 12/31/2022 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY 1xx AUTOS BODILY INJURY Per accident $ X HIRED NON-OWNED PeOracEciGent DAMAGE $ AUTOS ONLY AUTOS ONLY A X �13 X OCCUR EACH OCCURRENCE $ 3,000,000 CLAIMS-MADE S 2040359 08/27/2021 08/27/2022 AGGREGATE $ 3,000,000 TENTION$ 0 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N WC 9059522 08/27/2021 08/27/2022 500,000 PROPRIETORIPARTNERIEXOFFICER/MEMBER EXCLUDED?ECUTIVE F N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Leased/Rented S 2040359 08/27/2021 08/27/2022 50,000 Equipment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE nU�Z��.IB-GiG ACORD 25(2016/03) ,✓ ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD