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Home My WebLink AboutCertificate of Liabiliy . ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE TM 11/10/2005 PRODUCER Garrett-Stotz Company THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE /-\i 6011 Brownsboro Park Blvd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite B i ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Louisville KY 40207 -1292 INSURERS AFFORDING COVERAGE INSURED Team Contracting, LLC INSURER A: Amerisure Comoanies P. O. Box 261 INSURER B: Amerisure Comoanies Sellersburg IN 47172 INSURER c: INSURER D: I INSURER E: 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 DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI)3ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS OTH- EL. EACH ACCIDENT $ 100,000 EL. DISEASE - EA EMPLOYEE $ 100,000 E. L. DISEASE - POLICY LIMIT $ 500,000 SPECIAL RlSK/V ARlOUS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [2[] OCCUR 01/01/2005 01/01/2006 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- $ $ $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ CPP 1292821 LOC B 01/01/2006 01/01/2005 AUTOMOBILE LIABILITY CA 1292820 COMBINED SINGLE LIMIT (Ea accident) X ANY AUTO X X X X ALL OWNED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO $ EAACC $ $ $ AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: AGG 01/01/2005 01/01/2006 EACH OCCURRENCE AGGREGATE EXCESS LIABILITY CU 1292822 X OCCUR D CLAIMS MADE DEDUCTIBLE RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 1292430-07 01/01/2005 01/01/2006 B OTHE~QUIP FLOATER 01/01/2006 CPP 1292821 01/01/2005 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY END<?RSEMENTISPECIAL PROVISIONS ALL WORK INCLUDING ANNEX AREA 4 SANITARY SBWER, PUMP STATION AND FORCE MAIN JOB #8708-S-23 CERTIFICATE HOLDER X ADDITIONAL INSURED' INSURER LETTER: . A CANCELLATION 1,000,000 50,000 5,000 1,000,000 2,000,000 2,000,000 $ 1,000,000 $ $ $ $ $ $ $ 5,000,000 5,000,000 JEFFERSONVILLE SEWER BOARD 4TH FL., CITY-COUNTY BUILDING 501 EAST COURT AVENUE JEFFERSONVILLE IN 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 REPRESE T ES. AUT Z EPRE NTA V 47130 ACORD 25-S (7/97) @ACORD CORPORATION 198f . ' ,r i , I 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 representc:'ltive or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ~, ACORD 25-5 (7/97) TERRORISM COVERAGE :Rn>:ER ~'I I NOTICE-DISCLOSURE OF 'tERRORISM COVERAGE AND PREMIUM The Terrorism Risk Insurance Act 0(2002 establishes a program within the Department of the Treasury, under which the federal government shares, with the insurance industry, the risk of loss from future terrorist attacks. The Act applies when the Secretary of the Treasury certifies that an event meets the definition of an Act of Terrorism. The Act . provides that, to be certified, an Act of Terrorism must cause losses of at least five million dollars and must have been coriunitted by an individual or individuals acting on behalf of any foreign person or foreign interest to coerce the government or population of the United States. To be attached to and form part of Bond No. 4934028 , effective NOVEMBER 7,' 200:'> In accordance with the Terrorism Ri$k InsUrance Act of2002, we are providing this disclosure notice for bonds on which Great American Insurance Company, its affiliates (including, but not limited to Great American Alliance In,surance Company, Great American Insurance Company of New York and Great American Assurance Insurance Company) is the surety. r\ I The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the terms ofthe Act. The federal share equals 90% of that portion of the amount of such insured losses that exceeds the applicable insurer retention. I This Coverage PartlPolicy covers certain losses caused by terrorism. In accordance with the Federal Terrorism Risk Insuranc~ Act of2002, we are required to provide you with a notice. disclosing the portion of your premium, if any, attributable to the coverage arising from losses for Terrorist Acts Certifj.ed under that Act. The portion of your annual premium th8;t is attributable to coverage for Terrorist Acts Certified under the Act is : $:00. ~, I'""" S1029U (4-04) GREAT AMERICAN INSURANCE COMPANY@ Administrative Office: 580 WALNUT STREET. C!NCINNATI, OHio 45202 . 513-369-5000 . FAX 513-723-2740 The number of persons authorized by this power, of attorney is not-mQre than Six No.O 17163 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the G~EAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under and by virtue of tl)e laws of the State of Ohio, does hereby nominate~ constitute and appoint the person or persons named below its true and lawful attorney- in-fact, for it and in its name, place and stead to execute in behalf of thes~id Company, as surety, any and all bonds, undertakings and contracts of suretyship. or other written obligations in the nature thereof; provided that the liability Of the said Company on any such bond. undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below. Steven M. Garrett William A. Kantlehner, III Thomas J. Mitchell Name Deborah A. Yates Jeffrey A.Brown Diane L. Phelps : . Address all of ~ouisville, Kentucky Limit of Power all Unlimited This Power of Attorney revokes all previous powers issued in behalf of the attorney(s)-in-fact named above. IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this 22nd day of January , 2002 Attest GREAT AMERICAN INSURANCE COMPANY K;~?:~~~, h;}.'. ..../ ("c,~ ~~~:;;~ Assis[ont Secretary -t I (j)~L (]..~ ~ Divisional Senior Vh'e President STATE OF OHIO. COUNTY OF HAMILTON _ ss: DAVID C. KITCHIN (513-412-4602) 01 On this 22nd day of January, 2002 ,before me personally appeared DAVID C. KITCHIN, to me known, being . .1y sworn, deposes and says that he resides in Cincinnati, Ohio, tha(he is the Divisional Senior Vice President of the Bond Division of Great American Insurance Company, the Company described in and which executed the :above instrument; thathe knows the seal of the said Company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By-Laws of said Company. and that he signed his name thereto by like authority. KAREN L. BERRY NOTARY PU6.LlC, STATE OF OHIO My Commission Expires 02-16-09 ~ .'I?. ~ This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company by unanimous written consent dated March I, 1993. RESOLVED: That the Division President, the several Division Vice Presidents and Assistant VIce Presidents, or anyone of them. be and hereby is authoriz.ed. from time to time, to appoint one or more Attorneys-in-Facf to execute 011 behalf (!f the Company, as surety, any and all bonds, undertakings and contracts (~fsuretyship, or other written obligations in the nature thereof,- to prescribe their respective duties and the respective limits (if their authority; and to revoke any such appointment at any time. RESOLVED FURTHER: That the Company seal and the signature (!f any of the aforesaid officers and any Secretary or Assistant Secretary of the Company may be affixed by facsimile to any power of attorney or certificate (!f either given for the execution (!f any bond, undertaking, contract or suretyship, or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature (!fsuch officer and the original seal (if the Company, to be valid and binding upon the Company with the same force and effect as though manually <</fixed- CERTIFICATION I, RONALD C. HAYES, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and the ..-R e. solutions of the Board of Directors of March I, 1993 have not been revoked and are now ..in full force and.. effect. r "'\; . ..1 .... . . , Signed and sealed this 10TH day of NOVEMBER 2005 ~*~<~.... }' :>.\..":.......~t(.'\, (!/< ...~~\ - ~.. '\l'..}j '[~~~ (()Z)~ Assistant Se("ref(fr)' S1029U (4-04)