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HomeMy WebLinkAboutCommercial Pavers Inc ,----•- ••■IN LOUIPAV -01 BRAQUE ACORO DATE (MM /DD/YYYY) cP CERTIFICATE OF LIABILITY INSURANCE 12/12/2012 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: Neace Lukens - Louisville/ Assured NL Insurance Agency Inc PHONE FAx 2305 River Road (A/C, No, Ext): ( 502 ) 8 -2100 (A/C, No): ( 502 ) 894 -8602 E -MAIL Louisville, KY 40206 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Grange Mutual Casualty Co 14060 INSURED INSURER B : Kentucky Associated General Contractors Commercial Pavers, Inc. INSURER C : AGCS Marine Insurance Company 22837 1801 Payne St INSURER D : Louisville, KY 40206 INSURER E : INSURER F : I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM /DD/YYYY) (MM /DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C 4/1/2012 4/1/2013 DAMAGE TO RENTED 300 000 A X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X JECT PRO- LOC $ — _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A X ANY AUTO CPP2611938 4/1/2012 4/1/2013 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON -OWNED Pea cRdentDAMAGE $ AUTOS ( ) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE CUP2611939 4/1/2012 4/1/2013 AGGREGATE $ 10,000,000 DED RETENTION $ $ _ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER / N B ANY PROPRIETOR /PARTNER /EXECUTIVE 1 N /A 18803 1/1/2013 12/31/2013 E.L. EACH ACCIDENT $ 4,000,000 OF FICER /MEMBER EXCLUDED (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ 4,000,000 If yes, describe under 4,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Leased /Rented Equip MZI93016522 4/1/2012 4/1/2013 Per Item 1,250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) R Project: City of Jeffersonville, Indiana; Paving Material, Street Department, Milling alone ;Certificate Holder is hereby added as Additional Insured under the captioned insured's General Liability policy with respects to written contract. CERTIFICATE HOLDER CANCELLATION 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 A lq I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD