HomeMy WebLinkAboutCertificate of Liability Insurance
CSR DH DATE (MM/DDNYVY)
EZCONS1 01 07 08
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.
EACH OCCURRENCE $ 1,000,000
11/30/08 $ 100,000
$ 5,000
PERSONAL & ADV INJURY I $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2 ,000,000
Ern . Ben I 1,000,000
AUTO 6t.JLY - EA ACCIDENT $
EA ACC $
AGG $
$3,000,000
$ 3,000,000
$
$
$
TORY LIMITS I X i ..ER-
I EL EACH ACCIDENT 1$4000000
1_'_'__ ......--. ...~-----.-I--..... ..--..-.-"-'
EL DISEASE - EA EMPLOYEEI $ 400000
EL DISEASE - POLICY LIMIT $ 4000000
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL !!- DAYS WRITTEN
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
A c.fJRQ..
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
Associated Insurance Service
B-O. Box 23410
? 'isville KY40223-0410
h!one:502-.24:t.::-70n Fax: 502-241-7843
INSURED
I
I
IINSU~ERS AFFORDING COVERAGE
~ INSURER A Grange Mutual Casual ty co;'p,;ni
INSURER B: '-'C,.:,,;
C..." 'n,'~; Y.:l';'
; ~
ri Associated Generi;--,t6~t'~':
INSURER C.
: INSURER 0:
INSURER E:
't}t\'~r~',:':i_".T~;\'.j> " .
:E_Z.hC9nit~uction'Co., Inc.
7420 b~stribution Dr.
Louisville KY 40258
. "'.. -t< ~;':;;~':..
COVERAGES
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER
GENERAL LIABILITY
.,
~~_l-~~MMERCIAL GENE~~IABILlTY CPP 2312427
i i . CLAIMS MADE I X i OCCUR
"--_1..__ :-=.J
H
I
11/30/07
A
A
, .r'~.:-,
BODILY INJURY
~er acci~~nt) ..
i PROPERTY DAMAGE
(Per accident)
LOC
CPP2312427
11/30/07
I COMBINED SINGLE LIMIT
11/30/08 (Ea accident)
BODilY INJURY
(Per person)
SCHEDULED AUTOS
~ ::~~~NT~~i8~J;'.
1---'-\
fX~ 5.00 Ded.ComE........___
X 500 Ded Col.1
GARAGE LIABILITY
ANY AUTO
OTHER THAN
AUTO ONLY:
EXCESS/UMBRELLA LIABILITY
A X OCCUR 0 CLAIMS MADE
I ~ DEDUCTIBLE
Ix RETENTION $10,000
WORKERS COMPENSATION AND
, EMPLOYERS' L1ABILI1Y
C i ANY PRvI'Rli::TClR/PARTNEPJEXECUTi\ic
I OFFICER/MEMBER EXCLUDED?
I If yes, describe under
SPECIAL PROVISIONS below
OTHER
EACH OCCU~RENCE
AGGREGATE
OE2312428
11/30/07
11/30/08
17624
01/01/08 i
12/31/08
A Equipment Floater i CPP 2312427 11/30/07 11/30/08 Rented
A Install/Builders R CPP 2312427 11/30/07 11/30/08
DESCRIPTION OF OPERATIONS / lOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: CHARLESTOWN PIKE SIDEWALKS PHASE 2 CERTIFICATE HOLDER IS ADDITIONAL
INSURED RESPECTS GENERAL LIABILITY FOR woRK PERFORMED BY THE INSURED PER
SIGNED CONTRACT
CERTIFICATE HOLDER
JEFFVB1
r
" )
JEFFERSONVILLE BOARD OF PUBLIC
WORKS AND SAFETY
500 QUATERMASTER COURT
JEFFERSONVILLE IN 47130
ACORD 25 (2001/08)
NAIC#
I 14060
!
,+--
LIMITS
$ 1,000,000
1$
I
'$
+-~--_. ..-----
I :
:$
400,000
250,000
f'l
J
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on 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 endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
I...~ ,
~
I
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ACORD 25 (2001108)