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HomeMy WebLinkAboutCertificate of Liability Insurance - 2004 AGCRa CERTIFICATE OF LIABILITY INSURANCE 06/30/2004' PRODUCER (317)251-7100 FAX (317)259-1704 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pill ar Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 727 E. 86th Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 40309 Indianapolis, IN 46240 INSURERS AFFORDING COVERAGE NAIC# INSURED Gilliatte General Contractors, Inc. INSURER A: Amerisure Companies 2515 Bloyd Ave. INSURERB: Fireman's Fund Insurance Co. 21873 Indianapolis, IN 46218-3654 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDINI 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRQ DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY CPP2016617 01/01/2004 01/01/2005 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 PRFMI.SFS(Fa occurcnra) CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000 A X xcu included PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY n JE n LOC AUTOMOBILE LIABILITY CA20166160 01/01/2004 01/01/2005 COMBINED SINGLE LIMIT (Ea accident) $ X ANY AUTO 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CU2016618 01/01/2004 01/01/2005 EACH OCCURRENCE $ 10,000,000 X ] OCCUR CLAIMS MADE AGGREGATE $ 10,000,000 A $ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND WC2016619 01/01/2004 01/01/2005 X TORY LIMITS OTH- ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Bui on� R der's Risk MZI97906615 06/30/2004 06/30/2005 $1,468,100, Special B Excess Umbrella XTM00086153939 03/01/2004 01/01/2005 $1,000,000 ea. occur. $1,000,000 aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Project: Carmel City Center Streetscapes, Carmel , IN 46032 Certificate Holder is added as additional insured on the general liability but only with respects to liability arising out of the work performed by or on behalf of the named insured for the above referenced job and in accordance with the written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Carmel Redevelopment Commission for the 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Carmel BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY One Civic Center OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Carmel , IN 46032 AUTHORIZED REPRESENTATIVE Philip Peterson/SW ;(4,0144". ACORD 25(2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) 1