Matters ▸ Attachment
Drain LaMountain — File 26-0540
CERTIFICATE HOLDER
CANCELLATION
AUTHORIZED REPRESENTATIVE
©1988-2009 ACORD CORPORATION. All rights reserved
ACORD 25 (2009/09)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required)
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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
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.
CERTIFICATE NUMBER:
REVISION NUMBER:
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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).
INSR
LTR
ADDL
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
SUBR
WVD
GENERAL LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
(Mandatory in NH)
PRODUCER
INSURED
INSURER(S) AFFORDING COVERAGE
NAIC #
CONTACT
NAME:
PHONE
(A/C, No, Ext):
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #
FAX
(A/C, No):
INSURER C:
INSURER D:
INSURER E:
INSURER A:
INSURER B:
INSURER F:
N / A
COMMERCIAL GENERAL LIABILITY
GEN’L AGGREGATE LIMIT APPLIES PER:
LOC
POLICY
PRO-
JECT
CLAIMS MADE
OCCUR
$
EACH OCCURRENCE
MED EXP (any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
$
$
$
$
$
$
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
AUTOMOBILE LIABILITY
$
$
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
(Per accident)
$
$
$
$
CLAIMS MADE
DEDUCTIBLE
RETENTION $
OCCUR
EACH OCCURRENCE
AGGREGATE
$
$
$
$
$
$
$
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
Y / N
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
10825 Old Mill Rd
Omaha, NE 68154
(877)234-4420
CTL 1273 1830854
03/11/2026
04/01/2026 04/01/2027
X
28258
Continental Indemnity Co.
(877)234-4420
(877)234-4421
A
3 7 - 5 5 5 8 7 0 - 0 1 - 1 5
1,000,000
1,000,000
N
1,000,000
Applied Risk Insurance Services, Inc.
LaMountain Bros., Inc.
City of Somerville
37 Federal Hill Rd
Oxford, MA 01540
1 7 8 3 1 1 8
DAMAGE TO RENTED
PREMISES (Ea occurrence)
93 Highland Ave
Somerville, MA 02143