HomeMy WebLinkAbout10) Certificate of Liability Insurance
i ACORD",
CERTIFICATE OF LIABILITY INSlJRANCE ~~ib_3CGI DAT~~;~;~Y~)4
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Tobias Insurance Group, Inc.
9247 N. Meridian St. Ste. 300
Indianapolis IN 46260
Phone: 317-844-7759
INSURED
,
INSURER A:
St Paul Fire and Marine Ins Co
NAIC#
0052
0037
Fax: 317-844-9910
INSURERS AFFORDING COVERAGE
INSURER B'
Liberty Mutual Insurance Co.
American Contracting
& Services~ Inc.
P. O. Box :;)38
Jeffersonville IN 47131
INSURER c:
INSURER D:
INSURER E:
COVERAGES
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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'oOCUMENT WfTHRESPECT to WHICH iHfSCERTIFICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS,
INSR jADD'L POLICY NUMBER P~~~iri~~~~~~ Pg~\?eY(~~J:J!~~
LTR NSRD TYPE OF INSURANCE LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,00
-
A X COMMERCIAL GENERAL LIABILITY KKOBOO037 09/01/03 09/01/04 DAMAGe ,u ~c" , ow $ 300,000
PREMISES (Ea occurence)
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG 12,000,000
I Tx PRO- nLOC
POLICY X JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
A X ANY AUTO KKOBOO037 09/01/03 09/01/04 (Ea accident)
f--
AlL OWNED AUTOS BODILY INJURY
I-- $
X SCHEDULED AUTOS (Per person)
I--
X HIRED AUTOS BODIL Y I~IJURY
I-- $
NON-OWNED AUTOS (Per accident)
;! -
- PROPERTY DA,MAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT I
=1 ANY AUTO OTHER THAN EAACC $
AUTO ONLY: .~GG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000
B !:J OCCUR D CLAIMS MAOE LQ1Bn077589021 09/01/03 09/01/04 AGGREGATE , $ 5,000,000
$
~ DEDUCTIBLE $
RETENTION $ $
~l WCSTATU~ I IDTH-
WORKERS COMPENSATION AND X TORY LIMITS ER
A EMPLOYERS' LIABILITY i''1VK1300022 09/01/03 09/01/04 $ 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 500,000
if yes, describe under -
SPECiAl PROVISIONS belOw EL DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: BONENBERGER OAK GROVE
CERTIFICATE HOLDER
CANCELLATION
JEFF-05
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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CITY OF JEFFERSONVILLE
JEFFERSONVILLE DRAINAGE
BOARD
501 EAST COURT AVENUE
JEFFERSONVILLE IN 47130
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30
DAYS WRITTE
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08)
CORD CORPORA TIOI