HomeMy WebLinkAboutLIRR Cert of LiabilityAGREEMENT or CONTRACT #:
Long Island Rail Road
CERTIFICATE OF INSURANCE
PRODUCER: Parking, Southotd
ADDRESS:
Roy H. Reeve Agency Inc.
PHONE NUMBER: 13400 Main Road, Mattituck NY 1
INSURED:
Town of Southold
ADDRESS: ~/Q SQuthg!~Town Hall
· . F.U. ~ox ///~
Southold, N Y 11971
PHONE NUMBER:
CERTiFICATE
HOLDER:
AGReeMENT or CONTRACT Name I Description: ·
80081167301 : LIZ-1923; 14,300. SQ FT of Land for Unrestricted
Mattituck
RECEIVED BY MTA ~&IM:
Long Island Rail Road / MTA
Risk & insurance Management
146-01 Archer Avenue, Dept 1435
Jamaica. New Yort( 11435
At~: M. L. Cugini, Manager
Ir~umnce Standards & Enforcement
-- COVERAGES
POLICY
TYPE OF INSURANCE
I1-A2-RL-
)00022-00
~ Deducible $ 5~: C~0~ - q]~
ILITY
Any Auto
[] Owned Autos
i-J Hired Autos
[] Non-owned Amos
GARAGE LIABILITY
[] ANY AUTO
[]
EMPLOYER'S LIABILITY
(CheCk if applicable):
[] "At[ S~ates" Cove~'ag ·
Address:
(Se~ Note 2)
BUILDER'S RISK
[] Deductible $
[] Includes Environmental Liabi]it¥
)52
1/6/05
COMPANIES AFFORDING COVERAGE
American Alternative Insurance Ccm
lores I and 2~ .....
EFFECTIVE
DATE DATE
1/1/05 /1/06
BODILY INJURY OCC. $
BODILY INJURY AGG. $
PROPERTY DAMAGE OCC.
BI & PD COMBINED OCC. $ 1,00C, 000.
Bi & pD COMBINED AGG. $ 3,000,0C0.
PERSONALINJURYAGG. $ 1,000,000.
BODILY INJURY
PerPerson)
BODILY NJURY S
Per Accident)
PROPERTY DAMAGE $
BODILY INJURY &
PROPERTY DAMAGE $
COMBINED
AUTO ONLY-EA ACCIDENT $
OTHER TH~N EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $
AGGREGATE
[] STATUTORY LIMITS
EMPLOYER'S LIABILY'rY $
FULL CONTRACT VALUE of
OTHER I
RAILROAD PROTECTIVE LIABILITY insurance is NOT ACCEPTED on Certificate of Insumnca fo~ms - Provide detailed BINDER and/or poLICY.
CERTiFICATE. OF. INSURANCE (Continued) Page 2
National Railroad Passenger Corp. (Ammak)
[] New York & Atlan~c Ra;Iway Company
[] NJ Transit Rail Opera,OhS, Inc.
[] NAMED INSUREDS (See Note 3) iV' all that apply):
Coverage: Ali Risk Property, Builders Risk, etc.;
[] LOSS PAYEES (See Note 3) I.~ all that al)ply):
Coverage: Crime Insurance, Valuable Pal~ers, el.c.;
For all URR Agreements:
[] Long Island Rail Road (LIRR), Me{rol3ol[~an Transportation Author;ty (MTA)
and it's subsidiaries and affiliates
[] National Railroad Passenger Corp. (An~ak)
[] New York & Atisnbc Railway Company
NJ Transd Rail Operabons. Inc.
For LIRR Agreements involving MTA Capital Ce~.~r~cfi(m Comesny:
[] Capital Construction Company (CCC)
NOTE 1:
NOTE 2:
The subscribing insurance company(s), authorized to do business in the State of New York, certifies that insurance of the kinds and types and for
LJmifs of llabiliW herein stated, coverin9 the Agreement/Contract herein designated, has been procured by and furnished on behalf of the Insured and is
in full force and effect for the period listed on the front of this Certificate of Insurance. In edd~Jon, the subscribing insurance company(s) certifies that
the insurance limits for General Liability Insurance are not amended by deductible clauses of any nature excec)t as has been disclosed to and aDproved
by the Long island Rail Road (LIRR); and that coverage is afforded for the insured's obligations under that provision of the Agreement/Contrac~
providinG for ~ndemniflcation of the Indemnified parties, including the Long island Rail Road (LJRR}, named therein. Any exclusion applying to
construction or demolition o~eratlons on or within fifty (50) feet of railroad orooerty (stations. yards, tracks, etc.) has been voided. Any employe~
liability exclusion, which may otherwise operate to exclude claims for bodih/injury asserted by an employee of an edd~onal insured, shall be voided.
The subscdbing company(s) agrees that no policy referTed to herein shall be changed or canceled until thirty (30) days written notice has been given
to the Long Island Rail Road (URR), 146-01 Archer Avenue, Dept 1435, Jamaica, NY 11435 Attention: MTA Manager-Insurance Standards
& Enforcement.
NOTE 3: All references to Additional Insureds, Named Insureds and Loss Payees include those entities' directors, officers, employees, par~nsm, agents,
subsidiaries and affiliates.
NOTE 4: This certificate is issued to the Certificate Holder in consideration of the Agreement/Contract entered in~o with the named Insured. it is understood
and agreed that the certificate holder relies on the certificate as a basis for continuing such Agreement/Contracts with the named Insured.
AUTHORIZED INSUREPJPRODUCER
BY
) s.s.
COUNTY OF ~a r~o ~-/~-- )
TITLE
Jon E. Shearin ,,
i~hatum of authedzed Insurer/Producer)
~Vice President/Treasurer
20 o ~, before me personally came
, to me known, who
being duly sworn, did dap_gsa and say that he/she resides in ~ /- ~ c4~ ~.~-~,, ~- (~. , [nat ne/s~e Ls the
--~/"! d.~ /-~- ~ , ~,~ J~''~-/~x~t ~'u~ev'~f the corporation and described in and which executed the foregoing Certificate of Insurance, that he/she is
fully authorized to execute the foregoing Certificate of Insurance.
(Notary P~blic> --///'
LIRR - Revised 4-6-04