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. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
ACORD~ OP 10 D~
TEAMC-1 08/23/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Garrett-Stotz Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
10350 Ormsby Park Pl, Ste 105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Louisville KY 40223
~hone:502-415-7000 Fax:502-415-7001 INSURERS AFFORDING COVERAGE NAIC#
;SUREb INSURER A: Amerisure Mutual Insurance 23396
INSURER B:
Team Contracting, LLC INSURER C:
PO Box 237 INSURER D:
Memphis IN 47143
INSURER E:
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 BYTHE 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.
NSR[ TYPE OF INSURANCE POLICY NUMBER POI..f~lrl.':.'=f.ECWlE IPg~~Y(~~I~N LIMITS
LTR DATE MM/DDIYY DATE MM/DD
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
f--
A ~ COMMERCIAL GENERAL LIABILITY CPP 1292821 01/01/07 01/01/08 ~~IVI""'r:: ' ~ $ 50,000
I CLAIMS MADE ~ OCCUR PREMISES (Ea occurence)
MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $ 1,000,000
f----
GENERAL AGGREGATE $ 2,000,000
f----
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
h .nPRO- 'n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
f----
A X ANY AUTO CA 1292820 01/01/07 01/01/08 (Ea accident)
-
~ ALL OWNED AUTOS BODILY INJURY
$
~ SCHEDULED AUTOS (Per person)
~ HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
-
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000
A \!J OCCUR 0 CLAIMS MADE CU 1929822 01/01/07 01/01/08 AGGREGATE $5,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X \ TORY LIMITS I IU1H-
ER
A EMPLOYERS' LIABILITY WC 1292430-07 01/01/07 01/01/08 E.L. EACH ACCIDENT $ 100,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 100,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500 ,000
SPECIAL PROVISIONS below
OTHER
A EQUIP FLOATER Cpp 1292821 01/01/07 01/01/08 SPCL RISK VARIOUS
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ALL WORK INCLUDING UTICA-SELLERSBURG ROAD/S.R. 62 SEWER & WATER LINE
EXTENSION
CERTIFICATE HOLDER
CANCELLATION
COVERAGES
{
CITY OF JEFFERSONVILLE
JEFFERSONVILLE CITY HALL
500 QUARTERMASTER COURT
JEFFERSONVILLE IN 47130
0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI
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
REPRESENTATIVES.
AU~ES
@ACORD CORPORATION 198
ACORD 25 (2001108)
,~
, .
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.
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ACORD 25 (2001/08)