HomeMy WebLinkAboutcertificate of Liability Ins. Clark Shortline Railroad Co.
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.THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE sIDe OF THIS FORM.
i !.GENCY COMPANY BINOER# 12926
. Travelers Indemnity Company
L ~ .
ITob1as Insurance Group, Inc.
9247 N. Meridian St. Ste. 300
li:ndianapolis IN 46260
] [rick J. Ruti liano
, iAic, No. Ex!): 317-844-7759
,.gODE: G7004
! ~USTOMER 10: MITCH-O
I t~SURED
I Clark Shortline Railroad Co.
" (See Attached Binder Addendum)
i . 5100 Port Road
Jeffersonville IN 47130
INSURANCE BINDER
OP 10 C2
PM
THIS BINDER is ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY
PEREXPIRINGPOLlCY#: SPS6033C004
09/07/08
DATE
EFFECTIVE
AM
DESCRIPTION OF OPERATlONSJVEHICLES/PROPERTY (Including Locallon)
DATE (MMlDD/YYYY)
09/07/2007
DATE
TIME
X 12:01 AM
NOON
Reconstruction of Riverport No. 2 pump
station, including new wet valve, valve
vault and new pumps. Project includes
construction of a new concrete block pump
house.
LIMITS
DEDUCTIBLE COINS %
f-
f ~OVERAGES
j ; TYPE OF INSURANCE
) ~ROPERTY CAUSES OF LOSS
,C BASIC 0 BROAD 0 SPEC
J ;'
~ .
l,)
,~ERAL LIABILITY
j: COMMERCIAL GENERAL LIABILITY
ll,-i CLAIMS MADE [!] OCCUR
f!~ "ailroad Protective r.i8b
~
.:i: ~
:-E' AUTOMOBILE LIABILiTY
ANY AUTO
'7-
\:_ ALL OWNED AUTOS
i t SCHEDULED AUTOS
~
RETRO DATE FOR CLAIMS MADE:
EACH OCCURRENCE
RENTED PREMISES
MED EXP (Anyone person}
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS-COM~OPAGG
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per aOOdenll
PROPERTY DAMAGE
MEDICAL PAYMENTS
PERSONAL INJURY PROT
UNINSURED MOTORIST
COVERAGElFORMS
E
HIRED AUTOS
NON.QWNED AUTOS
!~UTO PHYS1CAL DAMAGE DEDUCTIBLE ~- ALL VEHICLES
! i'~ COLLISION:
Ui OTHER THAN COL:
GARAGE LIABILiTY
:.F ANY AUTO
~
o SCHEDULED VEHICLES
ACTUAL CASH VALUE
STATED AMOUNT $
OTHER
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE $
SELF-INSURED RETENTION $
WC STATUTORY LIMITS
EL EACH ACCIDENT $
EL DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
FEES $
TAXES $
ESTIMATED TOTAL PREMIUM $
ADDITIONAL INSURED
rrtC~ESS LIABILiTY
~ " UMBRELLA FORM
~-.;. OTHER THAN UMBRELLA FORM
RETRO DATE FOR CLAIMS MADE:
l~
WORKER'S COMPENSATION
AND
EMPLOYER'S LIABILiTY
This binder is issued pending receipt of the insurance policy and is
subject to the provisions and exclusions enumerated in the policy.
~ TiPECIAL
i i:ONDITIONSI
1~6~~~GES
! NAME & ADDRESS
l i
MORTGAGEE
" .
r
r~"
t
& '~':
;t :.
U~CORD 75 (2004/09)
AMOUNT
$2,000,000
$
$
$
$6,000,000
$
$
$
$
$
$
$
$
$
ACORD CORPORATION 1993-2004
INSURANCE BINDER NUMBER 12926
NAMED INSURED AND
MAILING ADDRESS:
INDIANA PORT COMMISSION, THE RAILROAD HOLDING
CORPORAT10N (A NOT-FOR-PROFIT ENTITY) PARENT
OF THE WHOLLY OWNED SUBSIDIARY CLARK
SHORTLlNE RAILROAD CO.
5100 PORT ROAD
JEFFERSONVILLE, IN 471304
NAME AND ADDRESS OF DESIGNATED
CONTRACTOR:
MITCHELL & STARK CONSTRUCTION CO., INC.
P. O. BOX 219
MEDORA, IN 47260
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NAME AND ADDRESS OF AUTHORITY FOR CITY OF JEFFERSONVILLE, INDIANA
WHOM THE WORK WILL BE PERFORMED: CITY COUNTY BUILDING 4TH FLOOR
501 E. COURT AVENUE
JEFFERSONVILLE, IN 47130
DESCRIPTION OF PROJECT:
$365,146
RECONSTRUCTION OF RIVERPORT NO.2 PUMP
STATION, INCLUDING NEW WET VALVE, VALVE VAULT
AND NEW PUMPS. PROJECT INCLUDES
CONSTRUCTION OF A NEW CONCRETE BLOCK PUMP
HOUSE.
CONTRACT COST:
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POLICY FORMS:
. CG 00 35 - COVERAGE FORM
. CG TO 05 - DECLARATIONS
. CG T 478 - EXCLUSION - ASBESTOS
. IL T3 68 - TERRORISM
. CG 21 70 - CAP ON LOSSES FROM TERRORISM
. VARIOUS - EXCLUSION - WAR LIABILITY
. VARIOUS - EXCLUSION - LEAD
. VARIOUS - EXCLUSION - NUCLEAR ENERGY
. APPLICABLE STATE AMENDATORY
ENDORSEMENTS
PROVISIONS:
THIRTY (30) DAY WRITTEN NOTICE OF CANCELLATION
SHALL BE PROVIDED TO THE INSURED, THE
CONTRACTOR, THE CITY OF JEFFERSONVILLE AND
STRAND ASSOCIATES, INC.
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