For All Other Excavation Permits:
Coverage Limits
General Liability 2,000,000
Aggregate BI & PD 1,000,000
Auto, Owned or Non-Owned-Pr
Occurrence
Liability BI & PD 1,000,000
Uninsured/Underinsured Motorist 50,000
Worker’s Compensation
Proof of Statutory Compliance
Manufacturer’s and
Contractor’s Liability
Aggregate 1,000,000
Per Occurrence 1,000,000
Property Damage
. 100,000
Builder’s Risk-100% of
Completed Value
Minimum Deductible 100
I
certify that this application is true and correct, and I agree to indemnify and
hold harmless the City of Huntingburg and its employees for any loss, liability
or damage that may result or accrue from or because of the applicant’s
negligence in performing the work under this permit, or providing the necessary
barriers and warning devices, or disregarding any legitimate order of the
Street Superintendent or his agents relating to any excavation or tunnel.
__________________________________________ ________________________
Signature of Owner or Owner’s Representative Date
Office
Use
Permit
Fee $_________ Date Permit
Issued___________ Approved
by_____________
Route
Copies to: Sara Electric Fire Gas Police
Safety Street Utilities……Waste Water Water