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HomeMy WebLinkAboutLIABILITY �-� ALLTPAV-01 LAU CERTIFICATE OF LIABILITY INSURANCE D04/27/2017 ATE(MM/DD/YYYY) 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 have ADDITIONAL INSURED provisions or 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: Epic Insurance Solutions,LLC PHONE 9700 Ormsby Station Rd Suite 200 (Arc,No,Ext):(502)805-3742 FAX 502)No):(502)805-2626 Louisville,KY 40223 ADORES :epic epicinsurancesolutions.com INSURERS AFFORDING COVERAGE NAIC# -- _ INSURER A:Travelers IndemnityCo of America 25682 INSURED INSURER 13:The Travelers Property Casualty Ins.Co.of America 25674 Allterrain Paving and Construction,LLC INSURER C:Travelers Casualty and Surety Company of America 31194 1638 East Market New Albany,IN 47150 INSURER D: INSURER E: INSURER F 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 ADDL SUBR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X] OCCUR X CO91­1690350 01/01/2017 01/01/2018 DAMAGE TO RENTED 300 OOO PREM I ES Ea occurrence $ MED EXP(Any one erson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER* GENERAL AGGREGATE $ 2,000,000 POLICY❑X PERLOC OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 A $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000 OO Ea accident , $ , 0 OWNED X OWNENY D O X 8109H689732 01/01/2017 01/01/2018 OSCHEDULED BODILY INJURY Per person) $ AUTOS ONLY AUTOS HIRED po BODILY INJURY Per accident $ AUTOS ONLY AUUTOS ONLYPROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR $ EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CUP91­1690350 01/01/2017 01/01/2018 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY X SPER —TATUTE OERH ANY PROPRIETOR/PARTNER/EXECUTIVE YIN UB9H692785 01/01/2017 01/01/2018 1,000,000 OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in NH If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Hopkins Lane Sidewalk Project-Owner-City of Jeffersonville Board of Public Works&Engineer-Jacobi,Toombs,&Lanz,Inc.1829 E.Spring St.,Suite 201 New Albany,IN 47150&all parties hereto and their respective heirs,executors,administrators,successors,and assigns are additional insured as respects general liability&auto liability when required by written contract.Coverage is Primary Noncontributory.30 Day Notice of Cancellation provided in favor of additional insureds. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Jeffersonville Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jacobi,Toombs&Lanz,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 500 Quartermaster Court Jeffersonville,IN 47130 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD