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Home My WebLink Aboutcoi orbik k lory (1)DATE (MM/DDIYYYY) ACORO� CERTIFICATE OF LIABILITY INSURANCE �� 09/30/2020 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 Alecia Whetsel NAME: Myers Insurance & Real Estate LLC p��NNo EX� :(765) 534-3154 Aic No :(765) 534-3155 PO Box 577 E-MAIL alecia m ers-a enc .com ADDRESS: CG Y g Y 923 N Main St INSURER S AFFORDING COVERAGE NAIC # Lapel IN 46051 iNsuReRa: Indiana Farmers Mutual 22624 INSURED Carl Orbik d/b/a American Pools and Flooring 1368 S. 300 E. Anderson IN 46017 COVERAGES CERTIFICATE NUMBER: INSURER B : INSURER D : INSURER F : 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 NUMBER MM/DDIYYW MM�DD/YYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ �,OOO,OOO X CLAIMS-MADE � OCCUR PREM SES�Ea occur ence $ � OO,OOO MED EXP (Any one person) $ 5,�� A CPP1013462 06/26/2020 06/26/2021 PERSONAL&ADVINJURY g 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $ Z,OOO,OOO JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $'� �OOO,OOO Ea accident ANY AUTO BODILY INJURY (Per person) $ A OWNED �/ SCHEDULED CAP1009931 �$/2$/2�2� �$/2$/2�2� BODILY INJURY (Per accident) $ AUTOS ONLY �� AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? � N � A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER Katie Lory 11399 Zanardi Court Zionsville, IN 46077 katielory10@gmail.com CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /_ � — �- _ I O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD