HomeMy WebLinkAboutAcord-6/14/2010 (2)AccoRRn CERTIFICATE OF LIABILITY INSURANCE
OP ID JH
HAUPT-4
DATE (MM/DDIYYYY)
06/03/10
PRODUCER
PDCM Insurance
P.O. Box 2597
Waterloo IA 50704
Phone:319-234-8888
INSURED
Fax:319-234-7702
Robert C Hau tly
203 Bisho St
Waterloo IIA 50707
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURERA Acuity Insurance Co.
INSURER 0: * Libert Mutual Insurance
NAIC a�
14184
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 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSRL
TYPE OF INSURANCE
POLICY NUMBER
DATE (MMIDD/YY` YE DATE MM/DD)YYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X I X COMMERCIAL GENERAL LIABILITY L77213
02/07/10
02/07/11
"-DA-MA,t IUHtN I tU
PREMISES (Ea occurence)
$ 100,000
r—
j CLAIMS MADE I X I OCCUR
MEO EXP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
s 2,000,000
GEL AGGRE�GATE LIMIT APPLIES PER ;
PRODUCTS - COMP/OP AGG
$ 2,000,000
, POLICY I js R j 1 LOC
A
�AUTOMOBILE LIABILITY
--, i
'��l ANY AUTO L77213
02/07/10
02/07/11
COMBINED SINGLE LIMIT
(Eaacudent)
$ 1000000
ALL OWNED AUTOS 3
X SCHEDULED AUTOS !
--
BODILY INJURY
(Perperson)
_
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accidem
LPROPERTY
$
DAMAGE
(Per accident)
$
.GARAGE LIABILITY =
-
AUTO ONLY - EA ACCIDENT
$
-
ANY AUTO
OTHER THAN EA ACC
$
I
AUTO ONLY AGG
$
EXCESS / UMBRELLA LIABILITY
EACH OCCURRENCE
S 4000000
A
X ;: OCCUR l_-1 CLAIMSMADE
L77213 06/02/10
02/07/11
AGGREGATE
$ 4000000
-_I
$
DEDUCTIBLE i
--
S
r RETENTION $
S
WORKERS COMPENSATION I
AND EMPLOYERS' LIABILITY
X WCSTATU- 1 0111-
B
Y / N
ANY OFFICER/MEMBEREXRTNER/�ECUTIVrIWC534S515229019 06/05/10
04/11/11
E.L. EACH ACCIDENT
$ 100000
(Mandatory In NH) J
E L DISEASE - EA EMPLOYEE
$ 100000
(/ yes describe under
SPECIAL PROVISIONS below I
E L DISEASE - POLICY MIT
$ 500000
OTHER
DESCRIPTION OP OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Waterloo and Engineer, AECOM, are named as additional insureds under
general liability.
i
CERTIFICATE HOLDER
CANCELLATION
WATEO 09
City of Waterloo
715 Mulberry St.
Waterloo IA 50703
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2009/01)
AUTHgi�EDREPRESENTATIVE
eide
.1988-2009 ACORD CORPORATI N. All rights reserved.
The ACORD name and logo are registered marks of ACORD