HomeMy WebLinkAboutCertificate of Liability Ins. E. H. Construction
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ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT' AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Acordla of KY-Loulsvil Ie
950 Breckenrldge Lane, Ste 50
\ P.O. Box 7809
Louisvil Ie KY 40257-0809
(502) 425-9444
INSURED
COMPANY
A
FCCI Ins. Co.
E H CONSTRUCTION LLC
POBOX 910
BROOKS, KY 40109
COMPANY
B Monroe Guaranty I nsurance Co.
COMPANY
<: KY Employers Safety Assn-KESA
COMPANY
[) St Paul Travelers
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..... "'THis'is'1-') CE'RTiFY THA T THE POLICIES OF INSURANCE LISTED BELOW HA"VEBEEN'ISSUED toTHEINSUREONAMECfAeOVE FORfHE pOLIC'lpER10'O
INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMORCONDITIONOFANVCONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICA TE MA Y BE ISSUED OR MA Y PERT AIN, 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.
CO TYPE OF INSURANCE POL.ICY NUMBER POL.ICY EFFECTIVE POL.ICY EXPIRATION
LTR DATE (MMIDDIYY) DATE (MMIDDIYY)
L.IMITS
A GENERAL. L.IABIL.ITY MOO0665317 12/31/04 12131/05 GENERAL AGGREGATE $ 2,000,000
COMMERCIAL GENERAL LIABILITY PRODUCTS.COMP/OP AGG $ 2,000,000
CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 100,000
MED EXP (Anyone person) $ 5,000
A AUTOMOBIL.E L.IABIL.ITY BOO0665317 12/31/04 12131/05
COMBINED SINGLE LIMIT $
J( ANY AUTO 1,000,000
ALL OWNED AUTOS BODIL Y INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE L.IABIL.ITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
B EXCESS L.IABIL.ITY COO0665317 12131/04 12131/05 EACH OCCURRENCE $ 5,000,000
X UMBRELLA FORM AGGREGATE $ 5,000,000
OTHER THAN UMBRELLA FORM $
C WORKERS COMPENSATION AND 4452104 12/31/04 12/31/05
EMPL.OYERS'L.IABIL.ITY $ 2,000,000
THE PROPRIETORI INCL EL DISEASE.POLICY LIMIT $ 2,000,000
P ARTNERS/EXE cun VE
OFFICERS ARE: EXCL EL DISEASE.EA EMPLOYEE $ 2,000,000
OTHER
D Bu i I der 's Risk 1 M03202387 12/31/04 12131/05 $10,000,000 Llmit/$2,500 Deductible
Leased/Rented Equipment $100,000 Limit $1,000 Deductible
DESCRIPTION OF OPERATIONSIL.OCATIONSIVEHICL.ESISPECIAL. ITEMS
Re: Jeffersonvl I Ie City Hall Quartermaster Renovation
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SHOUL.D ANY OF THE ABOVE DESCRIBED POL.ICIES BE CANCEL.L.ED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIL.L. ENDEAVOR TO MAIL.
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT,
BUT FAIL.URE TO MAIL. SUCH NOTICE SHAL.L. IMPOSE NO OBL.IGATION OR L.IABIL.ITY
OF Y KIND UPON THE COMPANY, ITS AGENTS OR. "REPRESENTATIVES.
AUTH RIZE REPRESENT IVE
City of Jeffersonvil Ie-Board
of Public Works
City County Building
501 E. Court Avenue
Jeffersonville, IN 47130
JEFFERY C DUNCAN
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CERTIFICATE: 046/001/ 00336
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IMPORTANT
If the certificate holder is an ADDITIONAL II\jSURED, 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 thi;; certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse llide 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.
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/
STPAUL
TRAVELERS
IMPORTANT DISCLOSURE NOTICE OF TERRORISM
INSURANCE COVERAGE
On November 26, 2002, President Bush signed into law the
Terrorism Risk Insurance Act of 2002 (the "Act"). The Act
establishes a short-term program under which the Federal
Government will share in the payment of covered losses caused
by certain acts of international terrorism. We are providing you
with this notice to inform you of the key features of the Act, and to
let you know what effect, if any, the Act will have on your
premium.
Under the Act, insurers are required to provide coverage for
o certain losses. caused by international acts of terrorism as defined
in the Act. The Act further provides that the Federal Government
will pay a share of such losses. Specifically, the Federal
Government will pay 900/0 of the amount of covered losses caused
by certain acts of terrorism which is in excess of an insurer's
statutorily established deductible for that year. The Act also caps
the amount of terrorism-related losses for which the Federal
Government or an insurer can be responsible at
$100,000,000,000.00, provided that the insurer has met its
deductible.
Please note that passage of the Act does not result in any change
in coverage under the attached policy or bond (or the policy or
bond being quoted). Please also note that no separate additional
premium charge has been made for the terrorism coverage
required by the Act. The premium charge that is allocable to such
coverage is inseparable from and imbedded in your overall
premium, and is no more than one percent of your premium.
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ILT-1018 (9/04)
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TRAVELERS CASUALTY AND SURETY COMPANY OF AMERlCA
TRAVELERS CASUAL T~r AND SURETY COMPANY .
FARMINGTON CASUALTY COMPANY
Hartford, Codnecticut 06183-9062
I
. .
POWER OF ATTORNEY AND. CER.l'IFIC. ATE OF AUTHORIT. Y OF ATTORNEY.(S)-IN-FACT
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KNOW ALL PERSONS BY TlIESE P~SENTS, THAT TRAVELERS CASUALTY AND SURETY. ~OMP AN'Y OF
AMERICA, TRAVELERS CASUALTY AND SURETVCOlYlPANY and FARMINGTON CASUALTY COMPANY, corporations
duly organized under the laws of the State of Connecticut, and having their principal offices in the City of Hartford, County of Hartford,
State of Connecticut, (hereinafter the <'Companies") hath made, constituted and appointed, and do by these presents make, constitute a~d
appoint: John S. Meehan, Paula J. Teague, Ruth Ann Herzog, Todd P. Loehnert, Pamela S. .C~~ter>Je.ffrey Duncan, Walter M.
Zolla, of Louisville, Kentucky, their true and lawful Attomey(s)-in-Fact, withfull power and authority hereby conferred to sign, execute
and acknowledge, at any place within the United States, the foll6wing instrument(s): by his/her sole signatw;e and act, any and all bonds,
recognizances, contracts of indemnity, and other writings obligatory in the natw;e of a bond, recognizance, or conditional undertaking and
any and all consents incident thereto, not limited to a specified dollar amount, and to bind the Companies, thereby as fully and to the
same extent as if the same were signed by the duly authorized, officers of the Companies, and all the acts of said Attomey(s)-in-Fact,
pursuant to the authority herein given, are hereby ratified and confIrmed.
This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are now in
full force and effect:
VOTED: That tJ1e Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and
Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of
a' bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and
revoke the power given him or her.
VOTED: That the Chairman, the President, any ViCe Chairman, any Executive Vice Pre$ident, any Senior Vice President or any Vice President may
delegate aU or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing
~ a copy thereof is filed in the office of the Secretary.
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'< 0TED: That any bond, recognizance, contract of indemnity, or wr~ting obligatory in the nature of a bond, recognizance, or conditional undertaking
shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice
President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary
and duly attested liI\d sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by one or more
Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company
officers pursuant to a written delegation of authority.
This Power of Attorney and Certificate of Authority is signed and sealed by facsimile (mechanical. or printed) under and by
authority of the following Standing Resolution voted by .the Boards of Dire~tors of TRAVELERS. C~,(!~!YAND S~'I'Y
COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETVCOMPANY and FARMINGTON CASUALTY
COMP ANY, which Resolution is now in f\lll force and effe~t: . . . '" '. ..,
1
VOTED: That the signature of each of the following offi~rs: President, any Executive Vice President, any Senior Vice President, any Vice President,
any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney
or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of
executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power ofattomey or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached.
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SPECIAL WORDING (11-00)
..--~!
IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AME:R]CA, TRAVELERS CASUALTY':
AND SURETY COMPANY and FARMINGTON CASUAl.TY CQMr ~y hav~.. c.~used this instrument to be signed by their Senior
Vice President, and their corporate seals to be hereto affixed thi~ 17th day of Februaiy, 2004. ~.
}SS. Hartford
COUNTY OF HARTFORD
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA.
TRAVELERS CASIJALTYi}ND ~URETY COMPANY
FARMINGTON CASUALTY COMPANY
. STATE OF CONNECTICUT
~~'
-
By
George W. Thompson
Senior Vice President
On this 17th day of February, 2004 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly sworn,
did depose and say: that he/she is Senior Vice President ofTRA VELERS CASUALTY AND SURETY COMPANY OF AMERICA,
TRAVELERS CA.SlJ~U;ry AND SURE1Y.. CO.M.....P.ANY.... aml........F.ARM. INGT.. ON. CASU.AL. TY COM. PAN.. Y. '.'. the. corp.. orations
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described in and which executed the above insti:ument; that hershe knoVfs the. seals of said <?orporations; that the seals affiXed to the said
instrument are such corporate seals; and that he/she executed the said instrument on behalf of the corporations by authority of his/her
office under the Standing Resolutions thereof. .. .....
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~~
My commission expires June 30, 2006 Notary Public
Marie C. Tetreault
/-....,
CERTIFICATE
I, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS
CASUALTY AND SURETY COMPANY andFARMI~GTON CASUALTY COMPANY, stock corporations of the State of
Connecticut, DO HEREBy'CERTIFY that the foregoing and attached Power of Att9rney and Certificate of Authority remains in full
force and has not been revoked; and furthermore, that the StaIlding Resolutions of the Boarc4> -Rf Directors, as set forth in the Certificate of
Authority, are now in force.
. J
Signed and Sealed at the Home Office of the Company, in the City of Hartford, State of Connecticut, Dated this
JULY ,20)% .
26th
day of
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By . .
Kori M. Johanson
Assistant Secretary, Bond
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