HomeMy WebLinkAbout04) Certificate of Liability Insurance
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ACORD CIERTIFICA TE OF LIABILITY INSURANCE i DAT!: (MMIOD
'TM. NOV 26 3
PRODUC1::R . THIS CEFlTIFICATE 1$ ISSUEtl AS A MAlTER OF INFORMATION
THE: E. DAVID MEENA COMPANY ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE
6004 BROWNSBORO PAFlK BLVD. STE C HOLDER. THIS CERTIFICATE DOES NOT AMENO, EXTEND OR
LOUISVlL\i.e KY 40201 AI. TaR THE COVERAG! AFFORO~D BY THE POLICIES BELOW.
PHONE: ~02-896.S66o ,
FAX: 502-jJ91.S620 INSURERS AFFORCING COVERAGE ; NJ IC;ll
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INSURED INSURER A:
DAN CRISrlANI EXCAVATING. INC. INSURER S: AMERICAN INTI!RNA TrONAC GRC;UP'"-''''' _. . '~'i~; ~-
1221 OLD HIGHWAY 31 E INSURER c: ST. PAUL FIRE &' MARINE INS. CO. --247l 17
CLARKSVillE IN <1712g -_....~ -~_.~. .....
I INSURER 0: .-. I
INSURER E: I
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COVERAGES _
THE POLICIE$ OF INSIIRANCF. USTEO BELOW KAVE ElEEN ISSUED TO THE IN$URE'O NAMeD AIlOVE FOR THE 1'0LlCY PERIOD INf)ICA1'eb. NOTWITH$'rAfoI(JlfoI(;
ANY REOUlOieMENT. TERM OR C:ONDITION OF ANY CONlRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAlij, THE INSURANCE AFfORDED llY THE POLIClES DESCRIBED HEREIN IS $UllJt:CT TO ALL TltE TERMS, eXCLUSIONIi ANC) CON(n'IION$ (H' $1I(""
POLlCIE~. AGGREGATELIMlrS SHOWN MAY HAY!:: BE::E:N REDUCED 8Y PAID CLAIMS.
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! GENERAL L1AIilIUTY
'NPE OF INSURANce
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POLICY NUMI3EIIt
GLO 3125a82.oa
OCT 1 1)4
EACH OCCURRENce
~MAGE TO FelTI!!)
! MED. EX!' (My One Pel!lOr\l
I. . . . .
I F'ERSONA.\ &. ADV INJlIrty
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. GENERAL AGGREGATE
IPRODUCTS.COMP/OP AGG.
x ' COMMERCIAL GliNEl-'.AL LIA8IL1 l'f
; I . ~ :.:
: ~_.1 CLAIMS MADE . .( 1 OCCUR
A I X i LiMITED POLLUTION
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I GEN'L AGGREGATE LIMIT AP"LIES PER:
I : fOLlCY ['u .-
'':~
I AUTC>M08lLE llABIUTY
.in x ~L=::~:
i ... lilR!':D AUTOS
I NON-OWN60 ill.ITOt.
BAP3725B81.00
OCT 1 03
OCT 1 04
i COMBINED SINGLE LIMIT
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i BOOIl.Y INJURY
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1-'"
'I BODilY INJURY
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PR(lPFRTY OAMA,(.;F
, GARAGE :LIABILI'lY
:--1 AN.,. AUTO
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AUTO ONLY. !:AACCrOGNi
OTHeR Tl1AN EA Ace $
AUTO ONLY:
i .l/Cl:.S$ i UMIlIii~I;;~LA f.1Ael~.ITY
iXl OCCUR :"1 W,IM$MADl:
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BL-
! OEDUCTlElLF.
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: x RETENTION 10 000
WORKERS CCMI"ENSA'nON ,INt>
~M PI.Oy!i;R3" I..IABlLITY
A ANV PRilP~'IiTOAIl>"'RTt.lR.'E~E"J'rl"R
OFFICERIMeMSER El!OLlJl)ED~
l:1yss, &Ii..e~tM .....d..r
: SPEcw. PRllVl!IONl boI....
.
. OTHEF\:INLANC MARINE
C . CAuse OF t.O$$: RISKS OF OIR!:CT
PHYSICAL LOSS
DESCRIPTION OF OPER~~TIONS/LOCATIONNEHIClESIEXCLUSIONS ADDED ENDORSEMENTI SPECIAL PROVISIONS
PROJEcrjJOB#: 9aO~O
4603-99~1
OCT 1 03
OCT 1 04
F.AC:H Or.r:URRFNr:F
AGGREGATE
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WC3725880.00
$
'X WCS 'ATV-! . OTHER i
: ..... ....TQf\y U""TS ;
; !:.L. EACt! ACCIDENT ! S
:E:i..-oiSEASE~EA EMPLOVEE i $
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E.L. DISEASE. POliCY l.IMIT . $
OCT 1 03
ocr 1 04
IM01500117
OCT 1 03
OCT 1 04
AL.L. RISK $3Q,OOO
ceRTIFICATE H lOEFl.
ADDITIONAL INSURIOO; tNSU"'r;r.r t.:~,
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CITY OF JEFFERSC'NVlllE
4TH FLOOR CITY CI)UNTY BUILOING
50115. COURT STREET
JEFFERSONVILLE, '1'>1 47130
Attention:. aOA~O OF' PUBLIC WORKS
ACORD ZS (2001/08)
Certifie:llle fI. 59GB
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$ 2, 00,000
LIMITS
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$ 1, 00,000
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CA/lICELLA TION
SIIOULD ANV or 11 Ie AOOVC DC$CRIBEC> F'ollCree 61: CANceLU;C B:FORe. T~ e
EXPIRATION DATE THEREOF, THE ISSUING COUPANY W1Lll:ND~VOR TO MAil 0
DAYS WAITTE:N NOTICE TO THE ceRl1FICATE HOl.DER NAMEO TO THE tEFI. t l.I"r
F^,LUR~ TO 00 SO SAAlJ..IMPOSE ND OBl.ICOoTION O~ LlAlllLITY or ANY KINO UI":>1 11le
INSURER. IT'S AGENTS OR REPRE:SE:N1' A11VEs.
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IMPORT ANT
. If the certificate holder is an ADDlitONAL INSURED, the policy(ies) must be endorsed. A statement
. Or] this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
: If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
: require an Emdorsement. A statement on tris certificate does not confer rights to the certIficate
· holder in lieu of such endorsement(s).
PISCLAIMER
: The Certific:;lte of insurance on the reverse side of this f<,rm does not constitute a contract between
: the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
. affirmativelV or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
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Certificate #SQ66
ACORD 25-S (2001108)
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