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� � DATE{PAdAiDDlYYYYj � <br /> A�!�� CERTIFICATE OF LtABILITY INSURANCE 0$/22/2019 I <br /> THIS CERTIFICATE IS ISSUED AS A MA7TER OF INFORMATION ONLY AND CONFERS NO RIGH7S UPON THE CERTIFICATE H4LbER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATfVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. TNIS CERTIFtCATE OF INSURANCE DOES NOT CONSTiTUTE A COPtTRACT BETWEEN THE ISSUtNG IRISUREt2(Sj, AUTHORIZED <br /> REPRESENTATlVE OR PROQUCER,AND THE CERTlF{CATE NOLDER, <br /> IMPORTANT: If the certificate holder is an ADDITIONAL 1NSURED,the policy{ies)must have ADDI710NAL INSURED provisians ar be endorsed. <br /> If SUBROGATION IS WAIVED,subjec#to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer righfs to ihe certiFicate hoider in lieu of such endarsemenf(s . <br /> PRODUCER CON?ACT <br /> Marsh Risk&Insurance Services NAME: <br /> CA LICBttS@�0437153 PHONE FAX <br /> AtC No: <br /> 633 W.Fifth Street,Suite 1200 E•MAIL <br /> Los Angeies,CA 90071 ADDRESS: <br /> AtN:losAngeles.GedRequest@Marsh.Com INSURER S AFF4RDING COVERA6E �ttvc# <br /> CN101348564-STND-GAUE-19-20 08 2019 iNsuaeRa,:ACEAmericanlnsuranceCom an 22667 <br /> iNsuRE AEC4M INSURER B:N/A �A <br /> 345 East Ash Avenue iNsutzeR c:Illinois Union Insurance Co 27960 <br /> Decatur,IL 62528 INsuReR D:SEE ACORD 101 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTEFIGATE NUMBER: LOS-442441494-43 REVISION NUMSER: <br /> THIS IS TO CERTIFY THAT THE PQUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO fiHE 4NSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> iNDICATED. NOTWITHSTANDING ANY REQt1IREMENT, TERM OR CdNDITION OF ANY CONTRACT pR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED QR MAY PERTAIN, 7HE INSURANCE A�FQRDED BY THE PQLfClES DESCRIBED HEftEIN IS SUBJEGT T4 AE� TNE TERNtS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> fLTR TYPE OF INSURANCE a6���$R POLICY NUMBER MM D�D YY Y MM p/YYYY LIMITS <br /> A X COMPRERCIALGENEt2ALLIABICITY NDOG71234137 O$IO1/2019 04161l2020 EACHpCCURRENCE $ 1,000,000 <br /> DAPtiAfi,E TO RENTED <br /> CtAtMS-MADE �OCCUR PREMISES Ea occurre ce �_,,,,,, _1,OQ0,000 <br /> MEd EXP(Any one person} $ ��pQ� <br /> � PERSONAL&ADV lNJURY $ �,�0,000 <br /> GEN'L AGGREGATE LlMIF APPLIES PER. GENERAL AGGREGATE $ 2,00O,OOQ <br /> X POLICY� PR� � LOC PRODUCTS-COMPlOP AGG $ 2=�Q�=�Q <br /> JEC7 <br /> OTHER: $ <br /> A AUTOMOBitE L�ABILITY ISA H252$0532 d4101/2019 04/01/2020 CpMB�NED SINGLE t1MiT $ 1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY WJURY(Per person) $ <br /> OWNED SCHEDUIED BODItY INJURY{Per accident} $� <br /> AUTOS qNLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS dNLY P r accident <br /> $ <br /> UMBRELL.A LIAB OCGUR EAGH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S_ <br /> DED RETENTION$ $ <br /> L} WORKERS COMPENSATION SEE ACORD 101 O4/O1/2019 O�/O1IZO2O }( PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER � <br /> ANYPROPRIETORIPARTNER/EXECUTIVE Y1� E.L.EAGH ACCIDENT $ 100,000 <br /> OFFICERlMEMBEREXCLUDED? � N�A ' " ' <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,004 <br /> If yes,describe under 1���Q <br /> DESCR1Pl It}N dF OpERATIdhtS betow E.L.DISEASE-POLICY LiMIT $ <br /> C ARCHITECTS&ENG. E4N G21654693(M}5 04/01t2419 d410912(I20 Per Gaim(Agg 1,000,000 <br /> PROFESSIQNAL UAB. "CLAfMS MADE" Defense inciuded <br /> DESCF2IPTION OF OPERATIONS!LpCAT10NS/VEHIC�ES (ACORD 101,Additional Remarks 5chedule,may be aktached if more space is required) <br /> Re:Proj Name:Substructure Repair Piarrs,PAaund Road over Stevens C�eek,�acation:Decatur,IL <br /> The City of Decatur and its officers and employees are named as additional insured for GL&Al coverages,but only as respects work performed by or on behalf of the named insured and where required by written <br /> carrttact. This insurance is primary and non-contributary over any existing insurance and(imited to Iiability arising out of the opera6ans of the named insured and where required by written contract with respect to the <br /> ��&AL coverages. <br /> CERTIFICATE HOLDER CANCEl.LA71dN <br /> City of Decatur SHOULD ANY QF THE ABOVE DESGRISED POUCIES BE CANCELLED BEFORE <br /> Attn:Matt Newell,Public Works Director THE EXPIRATIQN DATE FHEREOF, NOTkCE WtLL BE DELIVERED !N <br /> #1 Gary Anderson Plaza ACGORDANCE WITH THE POLICY PROVISIONS. <br /> Decatur,lL 62523-1196 <br /> AUTHORIZED REFRESENTATiVE <br /> of Marsh Risk&Insurance Services <br /> James L.Vogel <br /> O 7988-2016 AGORD CQRPORATION, All rights reserved. <br /> ACORD 25(2016/03) The ACORD n�me and logo are registered marks of ACORD <br />