The Hickman County Finance Office is accepting bids for "Concrete Pouring at Schools"
2025-2026.
Bid prices must be good for July 1, 2026 - June 30, 2027.
Specifications can be found at https://www.hickmank12.org/requestorproposalor
by calling 931-729-3391 Ext 3.
All bidders must attach:
A conflict-of-interest disclosure form can be obtained at
https://www.hickmank12.org/requestforproposal.
Iran Divestment Act Certification
Non-Boycott of Israel Certification
TN business license
A 1-million-dollar liability insurance certificate
Workers compensation insurance
Background Acknowledgement Form
Per TCA 49-5-406, all bidders' employees working on school properties must comply with all local,
state, and federal laws.
Sealed bids must be mailed or hand-delivered to the Hickman County Finance Office, 114 North
Central Avenue, Suite 203, Centerville, TN 37033, and clearly marked on the outside of the
envelope "Concrete Pouring at School."
Bids will be opened on May 12,2026 at 10:00 a.m. in the Finance Office.
The Hickman County Board of Education reserves the right to accept or reject any and all bids or
parts of bids and to waive any informalities that would prevent the acceptance of a
better Present bid. Penny Rockle
1 Bid Reed
Mists New
BJB Construction Company
bid attached
BEYOND JUST BUILDERS
REPONDJUST BUTLDERS BE
BJB
CONSTRUCTION COMPANY INC
BJB
1373 Holly Tree Gap Rd, Brentwood, TN. 37027
CONSTRUCTION
CONSTRUCTION
COMPANY
COMPANY
References:
1) Brent Stidham
Senior Maintenance Engineer
(Managing govt buildings in Brentwood TN)
City Of Brentwood
brent.stidham@brentwoodtn.gov
(615)533-5032
15+ Years as a customer
2) Ryan Edwards
Continuous Improvement Coordinator
Advanced Composites
Ryan.edwards@advcmp.com
(615)630-1843
15+ Years as a customer
3) Yvonne Parker
Sr. Specialist, Consumer Care National Facilities
T-Mobile
Yvonne.parker@t-mobile.com
(931)980-8867
8 Years as a customer
4) Wesley King
Service Manager
The Mathews Company
wking@themathewscompany.com
(615)394-8451
15+ Years as a customer
Office 615-457-3304
www.BJBConstruction.com
Specifications part B
BID FORM
(fill in below and attach to bid documents
SPECS: Concrete Pouring at Schools
SCOPE: This bid is a one-year bid price for flatwork forming, pouring, and finishing. All materials
and labor are to be included in the per-square-foot bid. The bid may specify a surcharge for delivery
in addition to the cost per square or linear foot if it is less than a full truckload of concrete.
All bidders must comply with TCA 49-5-406 regarding the prohibition on working with prior felons or
sex offenders on school properties. All workers must be randomly drug tested yearly, and bidders
must submit a letter affidavit stating that they are in compliance with this requirement and meet all
federal, state, and local laws.
Bidders must maintain and attach the following:
Contractor license for concrete work
1-million-dollar liability insurance certificate
Workers compensation insurance certificate
TN business license or TN contractor license for concrete work
The square foot rate is to include the following:
Excavation of dirt of not less than 8 inches, with 4 inches compacted 3/4 stone rock or pug
mix.
Formed and finished to level surfaces to not cause a trip or mower hazards.
All surrounding disturbed areas, rocks, and debris must be cleaned up. Areas are to be
finished with seed and straw.
Concrete finishing is to be smooth-troweled or broom-finished as specified for the specific
job.
Flatwork is to have wire and expansion joints sawed in. Rebar is used when needed.
All concrete is to 4500 psi unless otherwise specified.
Bid this work on the form and attach paper documents to the bid.
1. Flat work by square foot:
$10.45/sf
2. Rebar if needed:
$ +5.65sf
3. Surcharge for pours less than a truck load:
$ +9.89/sf
Ditch paving is to be excavated, formed and leveled to grade as to not cause trip hazards
and or mower damage. All disturbed areas are to be cleaned up free of rocks and finished
graded. Areas are to be seeded, and straw covered upon completion of work. All concrete
is to be 4500 psi unless specified otherwise.
Ditch paving by linear foot:
1. 3 ft. width
$ 67.80
2. 4 ft. width
$ 79.10
3. 6 ft. width
$ 101.70
Curbing repair/pouring: 18-inch width by 12-inch height.
$56.50
linear foot price
1 I Page
IRAN DIVESTMENT ACT CERTIFICATION
I understand that under the Iran Divestment Act, T.C.A. 12-12-101- - 12-12-113,
political subdivisions in Tennessee are prohibited from entering into any
procurement or contract over $1,000 with a person who engages in
investment activities in Iran. The state's chief procurement officer, as required
by T.C.A. 12-12-106, has created a list of persons who engage in investment
activities in Iran. Any person who is on the list is ineligible to contract with any
political subdivision of the State of Tennessee, and any such contract will be
considered void under T.C.A. 12-12-110. The list is published on the
Tennessee Department of General Services' website at:
https://www.tn.gov/content/dam/tn/generalservices/documents/cpo/library/o
po-library/public-information-
library/List of persons pursuant to Tenn. Code Ann. 12-12-
106 Iran Divestment Act updated with NY06-07-23. pdf
CERTIFICATION
By submission of this bid, each bidder and each person signing on behalf of
any bidder certifies, and in the case of a joint bid each party thereto certifies
as to its own organization, under penalty of perjury, that to the best of its
knowledge and belief that each bidder is not on the list created pursuant to
T.C.A 12-12-106.
Bidder Name: Nathaniel Benbow
Bidder Signature: Nathaniel Benbow
Date: 5/6/2026
2 I Page
Hickman County Government
Conflict of Interest Disclosure Form
The County Financial Management System of 1981 contains the most stringent conflict of
interest provisions. TCA $5-21-121 provides:
(a) The director, purchasing agent, members of the committee, members of the county
legislative body or other officials, employees, or members of the board of education
or highway commission shall not be financially interested or have any personal
beneficial interest, either directly or indirectly, in the purchase of any supplies,
materials, equipment or contractual services for the county.
(b) No firm, corporation, partnership, association or individual furnishing any such
supplies, materials, equipment or contractual services, shall give or offer, nor shall
the director or purchasing agent or any assistant or employee accept or receive
directly or indirectly from any person, firm, corporation, partnership or association
to whom any contract may be awarded, by rebate, gift or other otherwise, any
money or other things of value whatsoever, or any promise, obligation or contract for
future reward or compensation.
Date: 5/6/2026
Name: Nathaniel Benbow
Please describe below any relationships, transactions, positions you hold (volunteer or
otherwise), or circumstances that you believe could contribute to a conflict of interest:
I have no conflict of interest to report.
I have the following conflict of interest to report (please specify any boards or
committees you (and/or your spouse) sit on, the name of your employer and any
businesses you or your spouse may own.
I hereby certify that the information set forth above is true and complete to the best of my
knowledge.
Date: 5/6/2026
Signature: Nathaniel Benbow
3 I Page
Background Check Acknowledgement Form
Contractor is required to meet al TCA 49-5-406, local, state, and federal laws
regarding "workers on school properties." The Hickman County Board of
Education further requires that no prior felons, drug offenders, or sexual
registered offenders work on any school properties.
Contractors will be required to wear contractor provided identification when
on school premises. The contractor may be asked to provide proof of
background check.
Signature: Nathaniel Benbow
Print: Nathaniel Benbow
Title: Estimator/ Principal Officer
Date: 5/6/2026
4 I Page
State of Tennessee
Non-Boycott of Israel Certification
The Bidder certifies that it is not currently engaged in and will not for the duration of the
contract engage in a boycott of Israel as defined by Tenn. Code § 12-4-119. This provision
shall not apply to contracts with a total value of less than two hundred fifty thousand
dollars ($250,000) or to contractors with less than ten (10) employees.
According to the law, a boycott of Israel means engaging in refusals to deal, terminating
business activities, or other commercial actions that are intended to limit commercial
relations with Israel, or companies doing business in or with Israel or authorized by,
licensed by, or organized under the laws of the State of Israel to do business, or persons or
entities doing business in Israel, when such actions are taken:
1. In compliance with, or adherence to, calls for a boycott of Israel, or
2. In a manner that discriminates on the basis of nationality, national origin, religion, or
other unreasonable basis, and is not based on a valid business reason. Tenn. Code
§ 12-4-119
Signature: Nathaniel Benbow
Print: Nathaniel Benbow
Date: 5/6/2026
ï
5 I Page
W-9
Request for Taxpayer
Give form to the
Form
(Rev. March 2024)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
Go to www.irs.gov/FormW9 for instructions and the latest information.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1. and enter the business/disregarded
entity's name on line 2.)
BJB Construction Company Inc
2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check
4 Exemptions (codes apply only to
only one of the following seven boxes.
certain entities, not individuals;
see instructions on page 3):
See Specific Instructions on page 3.
Individual/sole proprietor
C corporation
S corporation
Partnership
Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership)
Exempt payee code (if any)
Print or type.
Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate
Exemption from Foreign Account Tax
box for the tax classification of its owner.
Compliance Act (FATCA) reporting
code (if any)
Other (see instructions)
3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification,
(Applies to accounts maintained
and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
outside the United States.)
this box if you have any foreign partners, owners, or beneficiaries. See Instructions
5 Address (number, street, and apt. or suite no.). See instructions.
Requester's name and address (optional)
1373 Holly Tree Gap Rd
6 City, state, and ZIP code
Brentwood, TN. 37027
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
-
-
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
or
TIN, later.
Employer identification number
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.
04 - 3777109
Part
11
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Signature of
Here
U.S. person
Debbie Benbow
Date 3/13/2026
General Instructions
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that it has direct or indirect
Section references are to the Internal Revenue Code unless otherwise
foreign partners, owners, or beneficiaries when it provides the Form W-9
noted.
to another flow-through entity in which it has an ownership interest. This
Future developments. For the latest information about developments
change is intended to provide a flow-through entity with information
related to Form W-9 and its instructions, such as legislation enacted
regarding the status of its indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
after they were published, go to www.irs.gov/FormW9.
requirements. For example, a partnership that has any indirect foreign
What's New
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
Purpose of Form
appropriate box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and enter its appropriate tax classification.
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they
Cat. No. 10231X
Form W-9 (Rev. 3-2024)
the
41904
State of Tennessee
14123171
BOARD FORLICENSING CONTRACTORS
CONTRACTOR
BJB CONSTRUCTION COMPANY INC.
This is to certify that all requirements of the State of Tennessee have been met,
ID NUMBER: 61519
STATE THE OF
LIC STATUS: ACTIVE
IDV
EXPIRATION DATE: September 30, 2026
$473,240.00; BC
GOREAT AGRICULTURE 7796*
IN-1313
VC
DEPARTMENT OF
COMMERCE AND INSURANCE
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
02/12/2026
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 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 NAME: LISA WILSON
INSURANCE GROUP OF AMERICA LLC
SMALL BUSINESS
PHONE:
FAX: (615)905-1698
6640 CAROTHERS PKWY STE 160
E-MAIL ADDRESS: lisa.wilson@iga.biz
FRANKLIN, TN 37067
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A
Central Mutual
20230
INSURED
INSURER B
All America
20222
BJB CONSTRUCTION COMPANY INC
1373 HOLLY TREE GAP RD
INSURER C
BRENTWOOD, TN 37027
INSURER D
INSURER E
INSURER F
CERTIFICATE NUMBER
7018655
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
INSR
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
Y
Y
9606838
8/8/2025
8/8/2026
EACH OCCURRENCE
$
1,000,000
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED PREMISES
$
300,000
(Ea occurrence)
CLAIMS-MADE
OCCUR
MED EXP (Any one person)
$
5,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PERSONAL & ADV INJURY
$
1,000,000
POLICY
PRO-
LOC
GENERAL AGGREGATE
$
2,000,000
JECT
PRODUCTS- COMP/OP AGG
$
2,000,000
B
AUTOMOBILE LIABILITY
Y
Y
9606837
8/8/2025
8/8/2026
COMBINED SINGLE LIMIT (Ea
$
1,000,000
accident)
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED
SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS
AUTOS
PROPERTY DAMAGE (Per
$
HIRED AUTOS
NON-OWNED
accident)
AUTOS
A
UMBRELLA LIABILITY
Y
Y
9606839
8/8/2025
8/8/2026
EACH OCCURRENCE
$
5,000,000
UMBRELLA
OCCUR
AGGREGATE
$
5,000,000
LIAB
EXCESS LIAB
CLAIMS-MADE
DED
RETENTION $
A
WORKERS COMPENSATION AND
9606841
8/8/2025
8/8/2026
WC STATUTORY LIMITS
OTHER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
1,000,000
ANY PROPRIETOR/PARTNERS/EXEC-
Y
UTIVE OFFICE/MEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$
1,000,000
(Mandatory in NH)
E.L. DISEASE- POLICY LIMIT
$
1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES
Certificate Holders are additional insured per the attached endorsements.
Subject to all of the terms, conditions, exclusions and definitions of the above referenced policies as issued by the carrier(s).
Excluded proprietors, partners, executive officers, and members:
DEBBIE BENBOW
BRUCE BENBOW
CERTIFICATE HOLDER
CANCELLATION
BJB CONSTRUCTION COMPANY INC.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
1373 HOLLY TREE GAP RD
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
BRENTWOOD, TN 37027
THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
LISA WILSON

## Table 1

| 1. Flat work by square foot: | $10.45/sf |
| --- | --- |
| 2. Rebar if needed: | $ +5.65sf |
| 3. Surcharge for pours less than a truck load: | $ +9.89/sf |

## Table 2

| 1. 3 ft. width | $ 67.80 |
| --- | --- |
| 2. 4 ft. width | $ 79.10 |
| 3. 6 ft. width | $ 101.70 |

## Table 3

| Bidder Name: | Nathaniel Benbow |
| --- | --- |
| Bidder Signature: | Nathaniel Benbow |
| Date: 5/6/2026 |  |

## Table 4

| (a) | The director, purchasing agent, members of the committee, members of the county legislative body or other officials, employees, or members of the board of education or highway commission shall not be financially interested or have any personal beneficial interest, either directly or indirectly, in the purchase of any supplies, materials, equipment or contractual services for the county. |
| --- | --- |
| (b) | No firm, corporation, partnership, association or individual furnishing any such supplies, materials, equipment or contractual services, shall give or offer, nor shall the director or purchasing agent or any assistant or employee accept or receive directly or indirectly from any person, firm, corporation, partnership or association to whom any contract may be awarded, by rebate, gift or other otherwise, any money or other things of value whatsoever, or any promise, obligation or contract for future reward or compensation. |

## Table 5

| Print: | Nathaniel Benbow |
| --- | --- |
| Title: | Estimator/ Principal Officer |
| Date: | 5/6/2026 |

## Table 6

| Print: | Nathaniel Benbow |
| --- | --- |
| Date: | 5/6/2026 |

## Table 7

|  |  |  |
| --- | --- | --- |
| page | [X] 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes. Individual/sole proprietor C corporation S corporation Partnership Trust/estate | 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): |
|  | LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) | Exempt payee code (if any) |
|  | Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. Other (see instructions) | Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) |
|  | 3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See Instructions | (Applies to accounts maintained outside the United States.) |

## Table 8

|  | 5 Address (number, street, and apt. or suite no.). See instructions. | Requester's name and address (optional) |
| --- | --- | --- |
|  | 1373 Holly Tree Gap Rd |  |
|  | 6 City, state, and ZIP code Brentwood, TN. 37027 |  |
|  | 7 List account number(s) here (optional) |  |

## Table 9

|  | Social security number |
| --- | --- |
| Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. | - - or Employer identification number |
| Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. | 04 - 3777109 |

## Table 10

| Sign Here | Signature of U.S. person Debbie Benbow | Date 3/13/2026 |
| --- | --- | --- |

## Table 11

| CONTACT NAME: | LISA WILSON |
| --- | --- |
| PHONE: | FAX: (615)905-1698 |
| E-MAIL ADDRESS: | lisa.wilson@iga.biz |

## Table 12

| INSURER(S) AFFORDING | COVERAGE | NAIC # |
| --- | --- | --- |
| INSURER A | Central Mutual | 20230 |
| INSURER B | All America | 20222 |
| INSURER C |  |  |
| INSURER D |  |  |
| INSURER E |  |  |
| INSURER F |  |  |

## Table 13

| LIMITS |  |
| --- | --- |
| EACH OCCURRENCE | $ 1,000,000 |
| DAMAGE TO RENTED PREMISES (Ea occurrence) | $ 300,000 |
| MED EXP (Any one person) | $ 5,000 |
| PERSONAL & ADV INJURY | $ 1,000,000 |
| GENERAL AGGREGATE | $ 2,000,000 |
| PRODUCTS- COMP/OP AGG | $ 2,000,000 |
| COMBINED SINGLE LIMIT (Ea accident) | $ 1,000,000 |
| BODILY INJURY (Per person) | $ |
| BODILY INJURY (Per accident) | $ |
| PROPERTY DAMAGE (Per accident) | $ |
|  |  |
| EACH OCCURRENCE | $ 5,000,000 |
| AGGREGATE | $ 5,000,000 |
|  |  |
| [X] WC STATUTORY LIMITS | OTHER |
| E.L. EACH ACCIDENT | $ 1,000,000 |
| E.L. DISEASE - EA EMPLOYEE | $ 1,000,000 |
| E.L. DISEASE- POLICY LIMIT | $ 1,000,000 |
|  |  |

## Table 14

| INSR LTR | TYPE OF INSURANCE | ADDL INSR | SUBR WVD | POLICY NUMBER | POLICY EFF (MM/DD/YYYY) | POLICY EXP (MM/DD/YYYY) |
| --- | --- | --- | --- | --- | --- | --- |
| A | [X] [X] [X] [X] GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT | Y | Y | 9606838 | 8/8/2025 | 8/8/2026 |
| B | [X] AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOS | Y | Y | 9606837 | 8/8/2025 | 8/8/2026 |
| A | [X] [X] UMBRELLA LIABILITY UMBRELLA OCCUR LIAB EXCESS LIAB CLAIMS-MADE DED RETENTION $ | Y | Y | 9606839 | 8/8/2025 | 8/8/2026 |
| A | WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERS/EXEC- Y UTIVE OFFICE/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below |  |  | 9606841 | 8/8/2025 | 8/8/2026 |