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An application was received from Brett Owens, requesting permission for a projecting sign at the premises numbered 579 Massachusetts Avenue approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutter
09/25/2019
Ginger M Maroon
Charles J Coughlin Insurance
14 Dinley Street
P. O. Box 10
Dracut, MA 01826
[email removed]
Main Street America Assurance Company
29939
Privitera Signs Michael P. Privitera
P. O. Box 2503
Salem, NH 03079
Safety Indemnity Insurance Company
33618
A
B
VIM Fitness
579 Mass Ave
Cambridge, MA 02139
MPP9019M
04/12/2019
04/12/2020
1,000,000
500,000
10,000
1,000,000
2,000,000
2,000,000
6213046
04/22/2019
04/22/2020
500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
INSR
ADDL SUBR
LTR
INSD
WVD
DATE (MM/DD/YYYY)
PRODUCER
CONTACT
NAME:
FAX
PHONE
(A/C, No):
(A/C, No, Ext):
E-MAIL
ADDRESS:
INSURER A :
INSURED
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF
POLICY EXP
TYPE OF INSURANCE
LIMITS
(MM/DD/YYYY)
(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE
$
DAMAGE TO RENTED
CLAIMS-MADE
OCCUR
$
PREMISES (Ea occurrence)
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
PRO-
POLICY
LOC
PRODUCTS - COMP/OP AGG
$
JECT
OTHER:
$
COMBINED SINGLE LIMIT
$
(Ea accident)
ANY AUTO
BODILY INJURY (Per person)
$
OWNED
SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY
AUTOS
HIRED
NON-OWNED
PROPERTY DAMAGE
$
AUTOS ONLY
AUTOS ONLY
(Per accident)
$
OCCUR
EACH OCCURRENCE
$
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
$
PER
OTH-
STATUTE
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
INSURER(S) AFFORDING COVERAGE
NAIC #
COMMERCIAL GENERAL LIABILITY
Y / N
N / A
(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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.
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).
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
CERTIFICATE HOLDER
CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCE
Brett Owens
Mike Privitera
Signed:
Signed:
Date:
Date:
10/17/2019
10/17/2019