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HomeMy WebLinkAboutCOI for CarmelAC RDP CERTIFICATE OF LIABILITY INSURANCE DA����DO g' CERTIFICATE MAYBE 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. THIS CERTIFICATE IS ISSUED ASA 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 15 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 endorsernent(s). PRODUCER CONTACT JASON SHEROAN _NAME, PHONE {317}579-9377 FAX (317)579-9378 AIC No Ext): A!C No MG ASYERS INSURANCE, LLC 3830 WEST 96TH STREET E-MAIL ADDRESS: JASON@MGiKYERS.COM INSURER(S) AFFORDING COVERAGE NAIC 9 INSURERA:ERIE INSURANCE EXCHANGE 26271 INDIANAPOLIS IN 46266 INSURED INSURERB:ERIE INSURANCE PROPERTY G CASUALTY CO 26830 INSURERC:OHIO CASUALTY INSURANCE 24074 CHRIS RAY INSURER 0: DBA: C RAY POOLS INSURER E! 1415 STANLEY RD INSURER 1. PLAINFIELD IN 46168-2329 COVERAGES CERTIFICATE NUMBER. CLI 932502878 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 LTR TYPEOFINSURANCE ADDL IND SUBR WVD POLICYNUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS X COMMERCFALGENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGA PREMIES(EaccuTO D 1,000,000 PREMISES Ea occurrence $ MED FXP {Any one person) $ 5,000 X Q39-2051168 3/20/2018 3/20/2020 PERSONAL & ADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER-, GENERAL AGGREGATE $ 2,000,000 POLICY a E T n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMIIINED SINGLE LIMIT a$ 1,000,000 Ea ccident BODILY INJURY (Per person) $ A X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X Q03-2031199 3/20/2019 3/20/2020 BODILY INJURY (Per accident) $ NON -OWNED X HIREDAUTOSX AUTOS PROPERTYDAMAGE Peracddent $ Medical payments $ 5,000 UMBRELLAIAe OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X PER OTH- STATUTEI ER E.L. EACH ACCIDENT $ -900,000 ANY PROPRIETORfPARTNERIEXECUTIVE $ OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) MIA Q87-7004315 3/20/2019 3/20/2420 E.L. DISEASE -EA EMPLOYEE $ 5D0,000 ITyes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE- POLICY LIMIT $ 5D D DOO C SURETY BOND 325606808 04/04/2019 04/04/2020 CITY OF CARMEL $5,()00 C SURETY BOND 325575711 5/15/2018 5/15/2019 CITY OF LEBANON $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES fACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CARMEL ENGINEERING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ONE CIVIC SQUARE ACCORDANCE WITH THE POLICY PROVISIONS. CARMEL, IN 46032 AUTHORIZED REPRESENTATIVE ACORD 25 (2014101) INS025 (201401) ON SEEROAN/JRS © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD