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HomeMy WebLinkAboutMike Ogg CITYO -1 OP ID: PF DATE (MMIDDIYYYY) AcoRV CE OF LIABILITY INSURANCE 01/22/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COOK ALTER TIRE COVERAGE CERTIFICATE THE POLIO E CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORT ANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies l A statement on this SU ROG not r subje the the terms and conditions of the policy, certain policies may require an endorse certificate holder in lieu of such endorsement(s). CON Jerry RauCk PRODUCER Phone: 812-246-6333 NA ME: ry 812 -246 -6335 PHONE 812_246 -6333 A/C No I ns Fax: 812 - 246 -6335 PH °"vo Ext Insurance and Investment Group E-MAIL • er r su - iig.com 301 East Utica St. ADDRESS: l ry i @ NAIL # er Ra rg, IN 47172 J INSURER(S) AFFORDING COVERAGE erry Rauck INSURER A : Travelers Insurance INSURED City of Jeffersonville INSURER B : Mike Ogg INSURER C 500 Quartermaster Court INSURER D : Jeffersonville, IN 47130 INSURERS : INSURER F : REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW H E ANY CONTRACO THE O THER OCUME WITH ROS ECT TO POLICY WHICH R IOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AY H BEEN REDUCE BY PA CLAIMS HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN POLICY EFF I po[I EXP LIMITS ADDL POLICY NUMBE MM /DD/YYW MM /DD/YYYY 1 INSR TYPE OF INSURANCE ►► LTR EAC OCCURRENCE GENERAL LIABILITY DAMA E T• R NTED $ 500,000 ZLP- 14T63484 01/01/2013 01/0112014 PREMISES Ea occurrence Excluded A X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS -MADE X I OCCUR 1'000'000 PERSONAL & ADV INJURY $ X $10,000 DedlOccu 2,000,000 GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ PRO- LOC COMBINED SINGLE LIMIT $ 1 �000�000 1 POLICY Ea accident AUTOMOBILE LIABILITY 01/01/2013 01/01/2014 BODILY INJURY (Per person) $ 810- 0B16514 A X AL AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE $ AUTOS AUTOS Per accident NON -OWNED $ HIRED AUTOS AUTOS EACH OCCURRENCE $ 4,000,000 UMBRELLA LIAB OCCUR $ 4 ZUP- 14T63496 01/01/2013 0110112014 AGGREGATE A X EXCESS LIAB � CLAIMS -MADE $ DED X RETENTION $ 10,000 X ORY LI ITS O R WORKERS COMPENSATION 1 ,000'000 AND EMPLOYERS' LIABILITY HJ- UB- 5C57996 01/01/2013 01/01/2014 E.L. EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N N A E.L. DISEASE - EA EMPLOYEE $ OFFICER /MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CANCELLATION CERTIFICATE HOLDER CITY - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF JEFFERSONVILLE ACCORDANCE WITH THE POLICY PROVISIONS. 500 QUARTERMASTER CT, STE 200 JEFFERSONVILLE, IN 47130 AUTHORIZED REPRESENTATIVE 6S1/7iPave..12. © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD