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�� � CERTIFICATE t�F LIABILITY iRISURANCE pATE(MMlDD/YYYY) �
<br /> AG'QRl7►
<br /> 5/28/2�19
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIa�
<br /> GER'iiFICATE DOES NOT AFFIRMATIVECY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORbED BY THE POUCiES
<br /> BELOW. THIS CEItTlFIGATE OF INSURANGE QOES NQT CQN5TITUTE A GONTRACT BETWEEN THE lSSUING INSUREI2{S}, AUTHORlZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the palicy(ies}must have ADDITIONAL INSURED provisians or be endoirsed.
<br /> If SUBROGATION IS WAIVED,subject to#he terms and canditians of the poliay,certain paiicies may require an endorsement. A statement an
<br /> this certificate does not confer rights to the certificate holder in lieu of sush eodarsement(s).
<br /> PRODUCER CON AC
<br /> NAME: M8 COCIO
<br /> Arthur J.Galiagher Risk Management Senrices, I�tC. pH°NE .217-233-3335 e,�c No:217-428-0$65
<br /> 101 S.Main St. Ste 200 E���
<br /> P.O. Box 140 nn �ss: ma corie a' .com
<br /> Deca#urtL62525 INSURERS AFFORDiNGCOVERAGE NAIC#
<br /> �rasu�R a:Travelers Rro Gasual Ca of America 25&74
<br /> INSURED iNsurefR s:Travelers Gasuai and Sure Co a#America 33194
<br /> Altorfer inc.
<br /> 280Q 6th Strest SW iNsu�R c:O!d Re ublic Insurance Gom an 24147 �
<br /> Cedar Rapids, IA 52444 INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTI�iCATE NUNI6ER:1803587644 REVISIOM WUMBER:
<br /> THIS IS TO CERTlFY THAT THE POLIClES OF IN3URRNCE L.ISTED 6ELOW HAVE BEEN ISSUED Tfl 7HE INSURED NAMED AB4VE FOR TNE FO�IGY PERIOQ
<br /> INDiCATED. NQTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT QR OTHER DOCUMENT WITH RESPECT TO WHICH 7HIS
<br /> GEFtTtFiCRTE MAY BE lSSUED OR NiAY PERTAIN, THE INSURANCE AFFflRQED BY TNE P4LfCIES dESCRlBED HEREIN !S SUBJECT TO ALl 7HE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH PpLiCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA�D CLAiMS.
<br /> tNSR TypE OF INSURANCE AD6l SUBR pp��CY NUM6ER MM/DD� MM/DY/YYYY LIMITS
<br /> LTR
<br /> C X C�ItAERCIAIGENERALLIABILlTY Y Y MWZY 314706 18 411/2019 3/1/2020 EACH OGCURRENCE $1,000,000 ,
<br /> CLAIMS-MADE �6GCUR PR MiSES Ea oN ur ence $a00,p00
<br /> MEO EXP(Any one perso�} $10,004
<br /> PERSONAL&ADV IN.lUftY $1,000,040
<br /> GEN'L AGGREGATE LIMIT APPUES PER: GENERALAGGREGATE $2,000,000
<br /> x POLICY�PE� �LOC PRqbUCTS-COMP/OP AGG $2,000,000
<br /> QTHER: $
<br /> C AUTOM48itElFABILiTY Y Y (�W(�3�47051$ 4J1J2019 311/262d CQMBINEDSINGLELiMtT g1,000,000
<br /> Ea accident „_,
<br /> X ANY AU70 BODiIY lNJURY{Per person} $
<br /> OWNED SGHEDULED BODILY INdURY(Per accident) $
<br /> AUTOS ONIY AllTOS —�����—��—
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTQS QNLY Pet accident
<br /> X Gara ekee er $
<br /> A X UMBRELLALIAB X pCCUR Y Y ZUP-91N11806-19-NF 4/1/2019 3/1/202p EACHOCCURRENCE $5,000,000
<br /> EXGESS llAB CLAIMS•MADE AGGREGATE $5,,OOQ,000
<br /> pED X RETENTION$ $ �
<br /> � WORKERS COMPENSATION Y lu1WG 314744 19 41112019 31112020 X
<br /> ANDEMPt4YERS'tEABiLITY STATUTE ERH �
<br /> ANYPROPRIETORlPAR7NERlEXECUTIVE Y�N E.L.EACH ACCIDENT $1,444,040
<br /> OFFFCEf21MEPABEREXCLUt?E6? � N!A ' —',
<br /> (Mandatory i�NH) E.L.DISEASE-EA EMPI.OYEE $1,000,000
<br /> if yes,describe under
<br /> bESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A CMartdMarineFloater QT-6B0-OH52352A-TIL-19 4J1J2019 3/1/202p LeasedlRentedEquip 1,000,800
<br /> B Crime 106088172 4!1/2U19 3/1/2020 Crime 1,000,000
<br /> DESCRIPTION OF OPERATIpNS/LOGATIONS/VEHICLES {ACQRD 701,Additional Remarks Schedule,may be attached iE more space is cequired)
<br /> The policies are endorsed#o provide btanket addi#ionat insured status per Form Numbers CG Z015,CG 24 10,CG 2037,CG 20 01 &CG 20 28.Coverage
<br /> includes primary and non-contributory coverage with waivers of subrogat�on to certificate holders andlar related entitiss,including subsidfaries and affiliates,
<br /> when/and as required by con#racf with Aitorter,inc.and its subsidiaries. This status is indicated by the appropriate box being checked above. For any
<br /> requirement af notice of cancetlation,the insured agrees to provide this per the terms of the cantcact.Blanketed Endorsements attached. �
<br /> CERTIFICATE HQLDER CANCELLA,TION
<br /> SHqU�D ANY OF TNE AB4VE DESCRIBED POLICIES BE CANCELI.ED BEfORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
<br /> City of Decatur Water Service ACCORDANCE WITH TNE POLiCX PROVtSIONS.
<br /> Attention: Randy Weaver
<br /> South Water Treatment Plant AUTHORIZEDREPRESENTAT �
<br /> 1155 Sauth Martin Luther King Jr.
<br /> Decatur IL 62521 j�� �� ' _„� '
<br /> O 1988-2015 ACORD CORPORATIQN. Ail rights reserved.
<br /> ACORD 25(2016J03} The ACORD name and lago are regtstered marks of ACORD
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