CONTRACTUAL INSURANCE REQUIREMENTS

The information contained herein is to describe the contractual requirements that Skender Construction LLC has indicated to myCOI. These contractual requirements should NOT be used to provide inaccurate information regarding current insurance policies. Questions regarding interpretation of this document can be directed to our support team at 317-759-9426.

INSURED

Fredericks Inc. 5448 W. Old 132 Pendleton, IN 46064

CARRIER REQUIREMENTS



POLICY LINE POLICY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS MADE DAMAGE TO RENTED PREMISES (Ea occurrence) $
X OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X PROJECT LOCATION $
AUTO LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000
ANY AUTO BODILY INJURY (Per person) $
X ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE (Per accident) $
X HIRED AUTOS
X NON-OWNED AUTOS
UMBRELLA /EXCESS LIABILITY X OCCUR EACH OCCURRENCE $ 5,000,000
Claims Made AGGREGATE $ 5,000,000
WORKERS COMP /EMPLOYEE LIABILITY X WC STATUTORY LIMITS OTHER
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
Property Property Causes of Loss Deductibles Building $
Basic Building Personal Property $
Broad Contents Business Income $
Special Extra Expense $
Earthquake Rental Value $
Wind Blanket Building $
Flood Blanket Pers Prop $
Blanket BLDG & PP $
$
$
Boiler and Machine Boiler & Machinery /Equipment Break Down $
$

Certificate Holder


Skender Construction, LLC C/O: myCOI P.O. Box# 501970, 8710 Bash Street Indianapolis, IN 46256

ADDITIONAL REQUIREMENTS


Division Name: 22-04-38 Adult & Child Health Indianapolis.
- Contract ID: 25896441-22-04-38.
- 30 Days Notice of Cancellation Required.

General Liability


- If unable to provide a “per project aggregate”, an Owners, Contractors & Protective Liability policy (OCP), in the name of the additional insureds shall be provided.
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OCP coverage shall include explosion, collapse, underground property damage, independent contractors, broad form property damage, punitive damage and blanket contractual liability, containing no limitation endorsement applying to liability assumed in the Contract Documents including indemnification of all additional insureds, are to be included.
- An electronic copy of the additional insured forms (CG 2037 10 01 & CG 2010 10 01 or equivalent) for both ongoing and completed operations must be submitted.
- An electronic copy of waiver of subrogation endorsement must be submitted.
- All policy lines - Deductible must be listed on certificate.
- In regards to the certificate for certificate holder Skender Construction LLC, the CERTIFICATE ADDRESS MUST BE LISTED ON CERTIFICATE - IN THE CERTIFICATE HOLDER BOX -AS FOLLOWS: "1330 W. FULTON ST., SUITE 200, CHICAGO, IL 60607."
- Waiver of Subrogation applies in favor of:1. Skender Construction LLC
2. Skender Construction of Indiana LLC
3. Skender Group LLC
4. Adult & Child Health
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: 1. Skender Construction LLC
2. Skender Construction of Indiana LLC
3. Skender Group LLC
4. Adult & Child Health,
- Additional Insured applies to General Liability.
- Please confirm on the certificate or by uploading endorsement(s) that Waiver of Subrogation applies to this policy.
- Please confirm on the certificate or by uploading endorsement(s) that Primary & Non-Contributory applies to this policy.

Automobile Liability


- An electronic copy of the additional insured endorsement must be submitted.
- An electronic copy of waiver of subrogation endorsement must be submitted.
- All policy lines - Deductible must be listed on certificate.
- In regards to the certificate for certificate holder Skender Construction LLC, the CERTIFICATE ADDRESS MUST BE LISTED ON CERTIFICATE - IN THE CERTIFICATE HOLDER BOX -AS FOLLOWS: "1330 W. FULTON ST., SUITE 200, CHICAGO, IL 60607."
- Waiver of Subrogation applies in favor of:1. Skender Construction LLC
2. Skender Construction of Indiana LLC
3. Skender Group LLC
4. Adult & Child Health
- Please confirm on the certificate or by uploading endorsement(s) that Additional Insured applies to this policy.
- Additional Insured Names: 1. Skender Construction LLC
2. Skender Construction of Indiana LLC
3. Skender Group LLC
4. Adult & Child Health,
- Additional Insured applies to Automobile.
- Please confirm on the certificate or by uploading endorsement(s) that Waiver of Subrogation applies to this policy.
- Please confirm on the certificate or by uploading endorsement(s) that Primary & Non-Contributory applies to this policy.

Umbrella Excess Liability


- Umbrella must follow form of General Liability, Employer's Liability & Automobile Liability.
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If Umbrella does not follow form, coverage must be Primary & Non-Contributory.
- All policy lines - Deductible must be listed on certificate.
- In regards to the certificate for certificate holder Skender Construction LLC, the CERTIFICATE ADDRESS MUST BE LISTED ON CERTIFICATE - IN THE CERTIFICATE HOLDER BOX -AS FOLLOWS: "1330 W. FULTON ST., SUITE 200, CHICAGO, IL 60607."

Workers Compensation


- An electronic copy of waiver of subrogation endorsement must be submitted.
- All policy lines - Deductible must be listed on certificate.
- In regards to the certificate for certificate holder Skender Construction LLC, the CERTIFICATE ADDRESS MUST BE LISTED ON CERTIFICATE - IN THE CERTIFICATE HOLDER BOX -AS FOLLOWS: "1330 W. FULTON ST., SUITE 200, CHICAGO, IL 60607."
- Waiver of Subrogation applies in favor of:1. Skender Construction LLC
2. Skender Construction of Indiana LLC
3. Skender Group LLC
4. Adult & Child Health
- Please confirm on the certificate or by uploading endorsement(s) that Waiver of Subrogation applies to this policy.
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