Laserfiche WebLink
f. t <br />COiIERAGES <br />CERTIFICATE NUMBER: 1757328167 <br />ILTR <br />TYPE OF INSURANCE <br />L <br />POLICY NUMBER <br />MM/DDIYYYY <br />MM/DDY EXP <br />LIMITS <br />A <br />X <br />X <br />N'OTHER: <br />COMMERCIAL GENERAL LIABILITY <br />MARINE GENERAL LIABILITY <br />CLAIMS -MADE Fx] OCCUR <br />DED 5,000 <br />L AGGREGATE LIMIT APPLIES PER: <br />POLICY X❑ �ECOT- LOC <br />Y <br />Y <br />ML202300002458 <br />4/21/2023 <br />4/21/2024 <br />EACH OCCURRENCE $1,000,000 <br />DAMAGE TO RENTED100,000 <br />PREMISES Ea occurrence) <br />ccurrence $ <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $2,000,000 <br />PRODUCTS -COMP / OP AGG $2,000,000 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />SCHEDULED <br />AUTOS <br />ANY AUTOIx <br />OWNED NON -OWNED <br />AUTOS ONLYAUTOS ONLY <br />X HIRED <br />AUTOS ONLY <br />AU202300019283 <br />4/21/2023 <br />4/21/2024 <br />COM,I ED SINGLE LIMIT <br />Ea accident $ 1,000,000 <br />BODILY INJURY (Per person) $ <br />BODILYINJURY(Peraccident) $ <br />PROPERTY DAMAGE <br />Per accident $ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS LIABILITYSTATUTE <br />ANYPROPRIETOR/PARTNER/EXECUTIVE YIN <br />OFFICER/MEMBEREXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under DESCRIPTION <br />OF OPERATIONS below <br />ALTERNATE EMPLOYER <br />X USL&H ENDORSEMENT <br />MARITIME EMPLOYERS LIABILITY <br />OCSL ACT <br />NIA <br />Y <br />WC202300024668 <br />4/21/2023 <br />4/21/2024 <br />® PER ❑ OTH- <br />ER <br />E.L. (Each accident) $ 1,000,000 <br />E.L. DISEASE (Ea employee) $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />$ <br />$ <br />$ <br />U.S. <br />COMPENSATION <br />LONGSHORE & HARBOR WORKERS <br />ACT <br />ALTERNATE EMPLOYER <br />MARITIME EMPLOYERS LIABILITY <br />OCSL ACT <br />N / A <br />PER OTH- <br />STATUTE ER <br />E.L. (Each accident) $ <br />E.L. DISEASE (Ea employee) $ <br />E.L. DISEASE - ANN AGG $ <br />AIRCRAFT <br />LIABILITY <br />OWNED AIRCRAFT <br />NON -OWNED AIRCRAFT <br />PASSENGER LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />$ <br />$ <br />$ <br />UMBRELLA <br />/ EXCESS LIAB 1 BUMBERSHOOT <br />UMBRELLA F-1 BUMBERSHOOT <br />EXCESS <br />CLAIMS MADE F OCCUR <br />DED RETENTION $ <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />$ <br />$ <br />ENERGY <br />CONTROL OF WELL/OPERATORS <br />EXTRAEXPENSE <br />CARE, CUSTODY AND CONTROL (CCC) <br />OFFSHORE OIL AND GAS PROPERTY <br />PLATFORMS <br />PIPELINES <br />ONSHORE OIL AND GAS PROPERTY <br />OIL & GAS PROPERTY <br />CONTRACTORS EQUIPMENT <br />NAMED WINDSTORM <br />CCC OFF- ON- <br />SHORE SHORE <br />CSL, ANY ONE <br />OCCURRENCE $ <br />(100% interest) <br />ANY ONE OCCURRENCE <br />100% interest $ <br />VALUES AS SCHEDULED $ <br />VALUES AS SCHEDULED $ <br />VALUES AS SCHEDULED <br />$ <br />VALUES AS SCHEDULED <br />$ <br />AGGREGATE <br />$ <br />VESSEL(S): AS PER ATTACHED SCHEDULE AS DETAILED IN THE DESCRIPTION OF OPERATIONS <br />DESCRIPTION OF OPERATIONS / LOCATIONS (ACORD 101, Additional Remarks Schedule, may be attached, If more space is required) <br />Marine General Liability Coverage including Protection and Indemnity: Additional Insured Ongoing and Completed Operations, Primary and <br />Non-contributory, Waiver of Subrogation per form OM DS 01 1120. <br />Automobile Liability: Additional Insured, as required by written contract, per form CA0001 (1120); <br />Workers Compensation: Waiver of Subrogation, as required by written contract, per form WC000313 (0484), Workers Compensation includes <br />USL&H. <br />ACORD 31 (2016103) Page 2 of 2 <br />