HomeMy WebLinkAboutBliss McKnight Inc JUL 1 1 2011
ACORDrM _ IN$URANCE BINDER BI,5f2D11
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
PRODUCER BINDER#
BASS McKnight, Inc. COMPANY Bituminous Casually Corporation 1000478
PO Box 157 EFFECTIVE EXPIRATION --
Bloomington, IL 61702-0157 DATE TIM DATE TIME
7!15/2011 12:01 H 911512011 — 12;I AV
PM NOON
TNB WADER IS IS&UED1O EXTEND COVERAGE N I THE ABOVE NAMED COMPANY PER EXPIRING POLICY;
CODE: SUB CODE: WC3540845
AGENCY DESCRIPTION OF OPERATIONSNEHICLESPROPERTY (inducting 10Cabon)
CUSTOMER ID:
INSURED
JEFFERSONVILLE, CITY OF
501 EAST COURT AVENUE
JEFFERSONVILLE, IN 47130
COVERAGES LIMITS ...
Property TYPE ANL) LOOA11ON OF PROPERTY COVERAGEPERILSFORMS AMOUNT DEDUCTIBLE T COINS %
LIABILITY COVERAGEIFORMS EACH AGGREGATE
OCCURRENCE
SCHEDULED FORAM 1 1 COPIPREHENSNE FORM BODILY INJURY
PREMISES&OPERATIONS PROPERTY DAMAGE
S DI & PO COMBINED
PRODUCTS COMPLETED OPERATIONS MEDICAL PAYMENTS PER PERSON
CONTRACTUAL PER ACCIDENT
OTHER PERSONAL INJURY
—
MEDICAL PAYMENTS
— PERSONAL INJURY FORMI J A I I B I I D
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
_ ANY AUTO BODILY INJURY (P&person)
ALL OWNEDAUTOS BODILY INJURY (Pa amden0
— SCHEDULED AUTOS PROPERTY DAMAGE
— HIRED AUTOS MEDICAL PAYMENTS
- NON.OWNED AUTOS PERSONAL INJURY PROT
— GARAGE LABILITY UNINSURED MOTORISTS
AUTO PHYSICAL DAMAGE 1 ALL VEHICLES I 1 SCHEDULED VEHICLES _ ACTUAL CASH VALUE
STATED AMOUNT
DEDUCTIBLE
COLLISIGY ` OTHER
OTHER THAN COL
EXCESS LIABILITY EACH OCCURRENCE
TJ UMBRELLA FORM AGGREGATE
OTMER IRAN UMBRELLA Far SELF - INSURED RETENTION
1 STATUTORY LIMITS
WORKERS COMPENSATION AND EACH ACCIDENT
EMPLOYER'S LIABILITY DISEASE - POLICY LIMIT
I, DISEASE - EA EMPLOYEE
SPECIAL
CONDITIONS/
OTHER
COVERAGES
NAME & ADDRESS MORTGAGEE ( ADDITIONAL INSURED
LOSS PAYEE X OTHER
LOAN NO
Maverick Insurance, LLC New Albany Office AUTHORIZED REPRESENTATIVE
Bliss McKnight, Inc.
2325 Green Valley Road
New Albany, IN 47150 t .
BY: Cn..wa_ "..C. ^7
L Connie Nardi - Taylor
ACORD ISM 02/ NOTE:IMPORTAMT STATE WFORANIION OH REVERSE SIDE SUM. R U 4T �R P0 71ATIDN iaea