ACCORD  CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
01/20/2005
Producer   (765)452-8267   FAX (765)454-6442
      Miles & Finch, Inc.
      P.O. Box 2224
      Kokomo, IN 46904-2224 		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                   NAIC#
Insured  Powerclean Inc and Powerclean Industrial Service
      P.O. Box 80345
      Fort Wayne, IN 46898 		Insurer A   Harleysville Lake States Ins                 14516
Insurer B   Accident Fund Company
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 NOT WITHSTANDING 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 LTR ADDL INSURD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YYYY) POLICY EXPIRATION DATE(MM/DD/YYYY) LIMITS
A  
GENERAL LIABILITY

COMMERCIAL GERERAL LIABILITY

 CLAIMS MADE    OCCUR



 

GEN'L AGGREGATE LIMIT APPLIES PER.

POLICY  Project  LOC
MPA1J1731 01/15/2005 01/15/2006
EACH OCCURANCE $ 1,000,000
DAMAGE TO RENTED PREMISES(Ea occurance) $ 100,000
MED EXP(Any One Person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
PRODUCTS COMP/OP AGG $ 2,000,000
A  
AUTOMOBILE LIABILITY

ANY AUTO
OWNED AUTOS
SCHEDULED AUTOS
HRED AUTOS
NONOWNED AUTOS
Hired Car Phy Dmg
$250,000 Limit
BA1J1731 01/15/2005 01/15/2006
COMBINED SINGLE LIMIT(Ea accident) $ 1,000,000
BODILY INJURY(Per person) $
BODILY INJURY(Per accident) $
PROPERTY DAMAGE $
   
GARAGE LIABILITY

ANY AUTO
     
AUTO             EA ACC
ONLY
EA ACCIDENT
                              AGG		 $
$
A  
EXCESS/UMBRELLA LIABILITY

OCCUR    CLAIMS MADE

DEDUCTIBLE
RETENTION
BE1J1731 01/15/2005 01/15/2006
EACH OCCURANCE $ 6,000,000
AGGREGATE $
6000000 $ 6,000,000
  $
  $
B WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
ANY PROPRETOR OR PARTNER EXECUTIVE
OFFICER MEMBER EXCLUDED
If yes, ...
SPECIAL PROVISIONS below		 WCV5016610 01/15/2005 01/15/2006
   
EL EACH ACCIDENT $ 500
EL DISEASE - EA EMPLOYEE $ 500
EL DISEASE - POLICY LIMIT $ 500
  OTHER        
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holders are named as additional insured on the general liability coverage
Workers Compensation waiver of subrogation applies on behalf of the certificate holders.
 
 
 
 CERTIFICATE HOLDER CANCELLATION
  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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE
Michael Wiles/MMAKI                         

Home | Information | Services | Equipment | Contact | Certificate of Liability Insurance
Copyright ©2003 POWERCLEAN INDUSTRIAL SERVICES