R2018-15 Professional Engineering Services Agreement Farnsworth Group Design Storm Drainage Improvements 32nd - Fulton Area

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Exhibit E ACCORa CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �,�i 1/26/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cottingham&Butler PHONE FAX Robert Heath •563-587-5000 A/C No):563-583-7339 Main St. E- 800 DRIESS: Dubuque IA 52001 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Hartford Fire Insurance Company 19682 INSURED FARNGRO-01 INSURER B:Travelers Property Casuafty Company of America 25674 Farnsworth Group, Inc. 2709 McGraw Drive INSURER C:Twin City Fire Insurance Co. 29459 Bloomington IL 61704 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:212831739 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY 83 LEN OB 8121 4/1/2017 4/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY Z PRO- JECT Fi] LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY 83UENOB8122 4/1/2017 4/1/2018 COEaMBIccident d..tl GLELIMIT $ a 1 000 000 1X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIAB X OCCUR ZUP-61M71617-17-NF 1/1/2017 4/1/2018 EACH OCCURRENCE _ $6,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $6,000,000 DED I I RETENTION$ $ C WORKERS COMPENSATION 83VVE088120 4/1/2017 4/1/2018 X I STATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEF—] NIA E L.EACH ACCIDENT $1,000,000 OFFICER/MEM BER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE:Farnsworth Group,Inc.Project 32nd&Fulton Ave Drainage Improvements RE:Farnsworth Group,Inc.Project Manager Brandon Lott The City of Decatur and its officers and employees are additional insured on the General Liability policy on a primary,non-contributory basis and the Auto Liability policy per written contract between the named insured and the certificate holder that requires such a status subject to the terms and conditions of the endorsement attached to the policy.A 30 day notice of cancellation is provided by the insurance company to the certificate holder as outlined by the endorsement attached to the General Liability,Auto Liability,and Workers'Compensation policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works Department ACCORDANCE WITH THE POLICY PROVISIONS. City of Decatur 1 Gary K.Anderson Plaza AUTHORIZED REPRESENTATIVE Decatur IL 62523 .0— @ ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD E-2