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OP ID:BG
'`' ° CERTIFICATE OF LIABILIT INSURANCE °A 12M oYw'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: H the certificate holder Is en ADDITIONAL INSURED, Oro pollcylles) must be endorsed IT SUBROGATION I6 WANED, 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 endorsemengs).
•
•RCOOCEa 888.836 -8449 NAME •
Maverick Insurance (J) 8124 4441010 IN _.. , No
Ste 206 ACORESS,'
2325 2325 Green Valley Rd ( PRODUCER pm/wpm
Now Albany, IN 47150 .. i
INO
. _. .. _ -..— . 014M1EXE) AFFORDING COVERAGE NMI• •
URID c of
Jeffersonville enemas :Indiana Public Employers' Plan i
Mayor Thomas Galligen INSURER o: Houston Casualty Insurance -- _ 42374 •_ I
600 Quartermaster Ct. '
INSURER .'
Jeffersonville, IN 47130.3672 INSURER O: •
I
IIEURERI: _.._
MEIRERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
• THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE UST170 B?W W HAVE BEEN ISSUE[) 10 PIE INSURED NAMED ABOVE FOR THE POLCY PERIOD
INDICATED. NOTWRHSTMDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WM RESPECT TO WHICH THIS
CERTFKATE MAY tE ISSUED) OR RAY PERTAIN, THE INSURANCE AFFORDED BY THE POLCC E3 DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS,
. EXCLUSIONS AND CONDITICNS OF SUCH POLICIES. LEVIES SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAMS.
TisR ADM WWI .. __ 1 b $I . .. warm
ITA TYPE COINSURANCE VIER LW' POLICY NUMBER MM9M n r4Mbd WYY 1
eWEMLLWML _ EACII OCCURRENCE a 1.000,000
0 X cGIaEIt:IAI. CFxFArl LItaYT'r 6X080210163 081000 08 s TCRtxIE ,AANANI a 150,00C
. -. I CLAUS.MWE El OCCUR CEO Exrlrnj,ulsF.IR!ly_ 1 10,000 •
X Prot uablllty PKG80210163 08/06110 08/08(11 PEASONAL A AMINJURY s !,000,00(
X t aw ErlfOrecement PKG80210163 08/06110 08106(11 NEL/ERAAOOREOATE _ s 3,000,000
OE/EL AGOREGAIL Lae; APPUCE WIO AGO PER ; PRODUCTS . O0PO $ 3,000,000
POLICY I r I I I LGG + $ .
AUTOMOBILE LMURRY swan SINGLE air i 1 • •
B X nr AV10 PKG80210163 08106710 08106/11 ITa MIRImU
o0Day IWURY Nr ovum •
ALL OWPCOAUTCS WILY INAIRYIP.t. .r) e •
�_ SCHEMED MJNOS PAOPFRTYOAVAGE f
•
HIRED w100 Rwoot«O
_ MNIdATIF0 AMT05 i
B X 1 E2600 ass PKG80210163 08/06110 08/06M1 s •
UMBRELLA LIP[) X oocM EACH OCCURRENCE a 4.000,000 •
MASS LIAS C.AILYHAADE we neonE s 4,0001000
B — PKG80210163 ' 08106110 08106!11 • ---
uoucnME II
X RETUmCI $ 10,000 �1OD s
WORKERS COMPENSATION X I J T VEEEMU. I 1
A EMPLOYERS' WDUTY r :
A ANT > CasM
ICRIRIT1I EXLCUMY: r i xrA 0066 -0100 07115110 07/16/11 •
E.L.CACIIAACF*WT E 1,000,O0C '
ofF RA•ENBEIERGI.UJIFy L QANWtay*NH) . El.0ISEASE -EA ES/LC/YEE 5 1,000,001 •
t LM
NYfP d M ELOSSFASE•PoRCYLNIT f 1,000000
)1LOL Malt. ITONOF OPERATORS Woe _ -- -t•..—
B CrimNBends PXG00110271 -I OMEN 08108111 Clime 500,000
I
orammes OF OPERATORS 1 ACCA110l4 /*MOLES IAGIATACOM 1M,AddNbnM RxnMM Scl.EJe. if PAN ptce la n\I
The Insured has crime coverage In the amount of $600,000 10 substitute for
the blanket bond to Insure Rho faNM ma
ul performance of ail elected
officials, empployees, commisslom members and persons acting on behalf of
Jeff Lo Go
CERTIFIC OLDER C NCELLATION
1111111
SIi0LD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE
me EXPIRATION DATE THEREOF. NOTICE WILL DE DELIVERED IN
To Whom It May Concern 3Y ACCORDANCEPATH 111E POUCY PROVISIONS.
dlchard Y. Jones
CLARK COUNTY RECORDER ANNONDFDABPREEENTAINE
' Piled foe Record as PresPaged Cr
I 201103261 Page 1 of 1 Cp�,r. —.
C7 Rote PO /72/2011 Thee 12:01:55
811088.2009 ACORD CORPORATION. All rights rase
ACORD 25 (2009109) The ACORD name and logo are reglatered marks of ACORD ..