DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 01/07/2025
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).
PRODUCER CONTACT Polyana Rodrigues
NAME:
Universal Insurance Agency, Inc. PHONE (508) 752-9333 FAX (508) 752-9303
(A/C, No, Ext): (A/C, No):
374 Belmont Street E-MAIL poly@universalinsagency.com
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
Worcester MA 01604 INSURER A : The Standard Fire Ins. Co. 19070
INSURED INSURER B : Safety Indemnity Insurance Company 33618
Leos Marble & Granite Inc INSURER C :
142 Rollstone St INSURER D :
INSURER E :
Fitchburg MA 01420 INSURER F :
COVERAGES CERTIFICATE NUMBER: 007 REVISION NUMBER:
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.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 300,000
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
MED EXP (Any one person) $ 5,000
A Y Y BIP7T450186 08/03/2024 08/03/2025 PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO- 2,000,000
POLICY JECT LOC PRODUCTS - COMP/OP AGG $
OTHER: ECONTRACTORS BLKT $
EQUIP SINGLE LIMIT
COMBINED
AUTOMOBILE LIABILITY $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $ 100,000
B OWNED SCHEDULED 5927996 11/28/2024 11/28/2025 BODILY INJURY (Per accident) $ 300,000
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $ 100,000
AUTOS ONLY AUTOS ONLY (Per accident)
Medical payments $ 5,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EAGLE ROCK MANAGEMENT, LLC, EAGLE ROCK ADVISORS, LLC, EAGLE ROCK PROPERTIES, LLC AND, EACH OWNER OF THE SITE(S)WHERE
WORK/SERVICE/PRODUCTS ARE PROVIDED, AND SUCH ENTITIES' SUCCESSORS AND ASSIGNS are included as additional insured on a primary &
non contributory basis for ongoing and completed operations for General Liability, when required by written contract. Waiver of subrogation applies in favor
of additional insured on General Liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Eagle Rock Management, LLC; c/o RealPage Vendor ACCORDANCE WITH THE POLICY PROVISIONS.
Credentialing
AUTHORIZED REPRESENTATIVE
P.O. Box 115006
Carrollton TX 75011
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
