44-014 (32) 08/31/2006 08:27 2037762288 DEWBERRY PAGE 011
WBERRY- GOODKIND , INC .
AUG 3 1 2006
FACSIMILE TRANSMITTAL SHEET
TO; FROM:
Dept of Bldg Inspection Guys Daddi
COMPANY: DATE:
City of Northampton,MA. 8/31/2006
FAX NIJM'R;FR TOTAL NO.OF PAGES INCLUDING COVER
413-587-1272 4
RE, YOUR REFERENCE NUMBER:
BP App—254 Old Wilson Rd 4363-04
0 URGENT El FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE
Please see attached contactor insurance and license information for the Building Permit
Application submitted for the Verizon Wireless installation at:
254 Old Wilson Rd,Northampton,MA
Please contact me at 203-776-2277 with any questions or comments
Thank •
Christopher
08/31/2006 08:27 2037762288 DEWBERRY PAGE 02
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08/31/2006 08:27 2037762288 DEWBERRY PAGE 03
Certificate of Liability Insurance Date of Issue01/04/2006
Producer This Certificate is issued as a matter of information
J. Cl/ton Avery Agency;inc.. only and confers no rights upon the certificate holder.
21$ou �Street This certificate does not amend,extend or alter the
PCBox15T1? coverage afforded by the policies below.
Wollebcfe,MN 03894--1510
(603)569�25lS __ ..- Companies Affording Coverage
Company C N A
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Insured GREEN MTN COMM Company C N A5.
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Green Mountain Communications Company
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PO Box 356 Company Continental Casualty
Wolfehoro Falls,NH 0389E-0356 0
Company Commerce&Industry
E
Company
F
Coverages
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 deetibed herein is subject to all the terms,exclusions and conditions of such policies,limits show may
have been reduced by paid claims.
Co I Type of Insurance Policy Number Policy Effective Policy Expiration Limits
Ltr I _ Date Date
General Liability General Aggregate $2,000,000 '
A L] Commercial General Liability C2082342699 12/31/2005 12/21/2008 Products-Camp/Op Aga $2,000,000
Claims Mad W Occurrence Personal&Adv Injury Si 000,000
❑ Owners&Contractors Prot Each Occurrence 31,000,000
❑ .Fre Damage(any one fire $300,000
Med Exp(Any one person) $10,000
Automobile Liability Camtined Sin9ie Limit $1,000,000
0 Any Auto C208234270it 12/31/2005 12/3112006
U All owned Autos Bodily Injury
(Per Person)
PI Scheduled Autos
Q Hired Autos Bodily Injury
W Non-Owned Autos {Per ACadent)
Property Damage
C Garage Liability Auto only Ea Accident
• Any Auto Other Than Auto Only:
❑ Each
_
__ .. _.. • Aggregate
Excess Liability E
U C2082342718 12/31/2005 12/31/2006 aci�Occurrence $S, ,
'(] Umbrella Form Aggregate _ $5,000000,000000
❑ Other Than Umbrella Form
i _ _
Workers Compensation and WC3a2091t3 12/31/2005 12/31/2006 WC statu- ErOther1.0,
fart Limits L_.
Employers'Liability EL Each Accident —r$ 0000000
Executive,officers ❑ Inc) EL Disease _AIL-Policy Limit 90,,680
ExCI EL ee Disease-Ea Em la
Y $1.000.000
Other
Description of Operations/Locations/Vehicles/Special Items _-..-J
Coverage as per terms and conditions of policy._ ^�
Cert'rficate Holder _ Cancellation
Should arty of the above described policies be cancelled before the
expiration thereof,the issuing company will endeavor to mail 30
Green Mountain Communications days written notice to the certificate holder named to the left,but
P 0 Box 356 failure to mail such notice shall impose no obligation or liability of any
kind upon the company,its agents or representatives.
Authorized Representative
Wolfeboro Falls,NH 03896 .Thomas A O'Dowd
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