HomeMy WebLinkAboutOverall Construction Co.�6-'/o/a
APPLICATION FOR'D�AINLAYEW S LICENSE="''
MANSFIELD, MA
DATE' -LWK- Z l59s
Name and/or Corporation: QvhWAu. Carr".
& Address: 86 4RfYM SY•
Emergency 24 hour telephone 3�y 3i5U 33 7- 6873
Please attach the following:
1. valid Heavy Equipment operators License (copy);
2. Insurance Certificate (Town must be listed as additionally
insured);
3. Performance Bond; our work with
4. Three references who e fam iar with y
telephone numbers'
5. Application fee f $250.00.
The undersigned he b ackn edges receipt, understanding of the
Drainlayer's Regulat nd that he/she has read the entire
document.
Signature:�1�-
DPW Approval:
Date:
) ISSUE DATE ( M/DD/
OS/30/95
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
NEW ENGLAND SECURITY INSURANCE AGENCY INC
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
200 CHAUNCY STREET - SUITE 100
POLICIES BELOW.
MANSFIELD, MA 02048
COMPANIES AFFORDING COVERAGE
COMPANY TRAVELERS -CHARTER OAR FIRE COMPANIES
A
LETTER
COMPANY TRAVELERS INDEMNITY COMPANY
B
INSURED
LETTER ,
OVERALL CONSTRUCTION CO INC.
COMPANY PHOENIX INSURANCE COMPANY
C
194 SPRING STREET
LETTER
MANSFIELD, MA 02048
COMPANY
D
LETTER
COMPANY E
LETTER
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.
CO! TYPE OF INSURANCE POLICY NUMBER
LTfl
POLICY EFFECTIVE !POLICY EXPIRATION LIMITS
DATE (MM/DD/VV) DATE (MM/DD/YY)
GENERAL LIABILITY
GENERAL AGGREGATE $ 2,000,000
A X COMMERCIAL GENERAL LIABILITY! I-660-493K7665COF-94 08/01/94 08/01/95 PRODUCTS-COMP/OP AGO. $ 2,000,000
;CLAIMSMADE $!OCCUR.
PERSONAL & ADV. INJURY $ 1,000,606
OWNER'S& CONTRACTOR'S PROT.
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any one fire) $ rO "600
MED. EXPENSE (Any one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE
$
ANY AUTO
LIMIT
ALL OWNED AUTOS
BODILY INJURY
$
B''X SCHEDULED AUTOS AO-BAP237J820-9-94
09/06/94 09/06/95 (Per person)
500,000
., X HIRED AUTOS
BODILY INJURY
$ 1,OOD,DOO
X', NO&OWNED AUTOS
(Per accident)
GARAGE LIABILITY
'.
PROPERTY DAMAGE $ 100,000
EXCESS LIABIUTV
EACH OCCURRENCE $
'UMBRELLA FORM
AGGREGATE .. $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
X STATUTORY LIMITS
C AND 6N-UB-674K218-7-95
EACH ACCIDENT $ 100,000
05/04/95 05/04/96
DISEASE —POLICY LIMIT $ 500,000
EMPLOYERS' LIABILITY
DISEASE —EACH EMPLOYEE $ ]_QQ QQQ
w OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
TOWN OF MANSFIELD IS AN ADDITIONAL INSURED
ATIMA
EXCAVATION
CEgTIFICA�E FiQLDER;;
CANCELLATION
TOWN OF MANSFIELD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
DEPARTMENT OF PUBLIC WORKS ':
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
BOB SWANSON
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
50 WEST STREET '.
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
MANSFIELD, MA 02048
I ILITY OF ANY KI UPON TH OMPANY, IT AGENTS OR REPRESENTATIVES.
\ EPRESENT VE /.
;Ab
G SE TY I CESGIN_C.ORPORATION
1996'
YY)