CERTIFICATE OF LIABILITY INSURANCE (7)
ACOBQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
OS/27/2005
PRODUCER (865)691-4847 FAX (865)694-4847 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
TIS Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1900 Winston Road, Suite 100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 10328
Knoxville, TN 37939-0328 INSURERS AFFORDING COVERAGE NAIC#
INSURED Phillips and Jordan, Incorporated F', ' INSURER A: American Contractors Insurance Cc RRG A VII
Attention: Steve Thompson INSURER B: ACIG Insurance Company A VII
6621 Wilbanks Rd ~ i INSURER c: Westchester Fire Insurance Compal y/WSRB A X
:~~
Knoxville, TN 37912 'l .; INSURER D: ACICRRG/Discover PIC Ins. Co. A II
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,
INSR DD'I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECllVE POLICY EXPlRAll0N LIMITS
GENERAL LIABILITY GD05045024 06/01/2005 06/01/2006 EACH OCCURRENCE $ 2,000,000
f-- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY $ 100,000
'I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 2,000,000
-
GENERAL AGGREGATE $ 4,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000
I rxl PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY AR05045015 06/01/2005 06/01/2006 COMBINED SINGLE LIMIT
- (Ea accident) $
X ANY AUTO D093A00018 FL 2,000,000
- RECEIVED
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
D X
HIRED AUTOS JUN 1 6 2005 ,~ ..,.. ~EIVED BODILY INJURY
<' t..., (Per accident) $
X NON-OWNED AUTOS
-
- :_'!~;:cr).\~ f?ECORDS AND J U t~ /] 3 2005 PROPERTY DAMAGE $
(Per accident)
I' -",...., .
GARAGE LIABILITY - ~ ";..;-,, : 'I ~ vk'V~-l uEPT AUTO ONLY - EA ACCIDENT $
R ANY AUTO RiSK IVI; NAGEMENT OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY CUW7810410 06/01/2005_ 06/01/2006 EACH OCCURRENCE $ 10,000,000
tKJ OCCUR D CLAIMS MADE AGGREGATE $ 10,OOO,OO(]
C $
~ DEDUCTIBLE $
X RETENTION $ 10,OO( $
WORKERS COMPENSAll0N AND WD05045045 06/01/2005 06/01/2006 X I T'1(~.JT ~JN~ I 10J~-
EMPLOYERS' UABIUTY WR05045016 500...000
-8--- -ANY,f'-ROP~ql&TQg,!P-AR+NE~Tj\llii,~ - '-, ~-- ----< ___n_ - - - E.L EACH ACCIDENT -' $
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under E:L DISEASE - POLICY LIMIT 500,000
SPECIAL PROVISIONS below $
OT1fER
f,ESCRJPll0N OF OPERA1l0NS I LOCAll0NS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
roject: Disaster Debris Removal, Reduction, and Disposal
Whe Certificate Holder is Additional Insured regarding General Li abi 1 ity and Automobile Liability with
regard to work performed by the Insured on this project.
Horne II
CANCE LATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
JL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOllCE SHALL IMPOSE NO OBLlGAll0N OR LIABILITY
33758-4748
OF ANY KIND UPON T1fE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTA11VE
Construction Div./CATWAR
f/c1k-
ACORD25(2001/08) FAX: (727)562-4052
@ACORD CORPORATION 1988