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�•� � DATE(MM/DD/YYYY) <br /> A�� CERTIFICATE OF LIABILITY INSURANCE 11/22/2019 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS = <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ,�i <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED p <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. v <br /> ¢ <br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If :: <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this ;� <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement�s). � <br /> m <br /> PRODUCER CONTACT .Q <br /> NAME: <br /> Aon Risk Services Northeast, IfIC. PHONE �g66) 283-7122 F� 800-363-olos `y <br /> soston Mn offi ce (AIC.No.Ext): AIC.No.): .a <br /> 53 state Street E-MAIL <br /> SUlt2 2201 ADDRESS: � <br /> 2 <br /> Boston MA 02109 USA INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURERA: COf110121'Cf & industry ins CO 19410 <br /> CDM 5mith Inc. �NsuReaa: �iberty Mutual Fire ins Co 23035 <br /> 75 State Street, 5uite 701 <br /> Boston MA 02109 USA iNsuaeac: �iberty Insurance Corporation 42404 <br /> INSURERD: LM Insurance Corporation 33600 <br /> INSURERE: L�OYCI's Syndicate rvo. 2623 AA1128623 <br /> INSURERF: ACE Property & Casualty insurance Co. 20699 <br /> COVERAGES CERTIFICATE NUMBER: 570074918000 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested <br /> LTR NPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS <br /> C X COMMERCIAL GENERAL UABILITY TB B T Z EACH OCCURRENCE Sl,OOO,OOO <br /> CLAIMS-MADE ❑X OCCUR PREMISES Eaoccurtence $5��,000 <br /> MED EXP(Any one person) $10,0�0 <br /> PERSONAL&ADVINJURY SZ,OOO,OOO p <br /> GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE S4,OOO,OOO � <br /> POLICY ❑X �E� ❑X LOC PRODUCTS-COMP/OPAGG $4,000,000 � <br /> OTHER: � <br /> 0 <br /> � <br /> B AUTOMOBILE LIABILITY as2-611-B8T8Z6-069 Ol/Ol/2019 Ol/Ol/2020 COMBINED SINGLE LIMIT � <br /> Ea accident $1,000,000 <br /> X ANYAUTO BODILY INJURY(Per person) Z <br /> OWNED SCHEDU�ED BODILY INJURY(Per accident) d <br /> AUTOS ONLY AUTOS PROPERTY DAMAGE � <br /> HIREDAUTOS NON-OWNED V <br /> ONLY AUTOS ONLY Per accident) ;� <br /> � <br /> N <br /> F X UMBRELLA LIAB X OCCUR XOOG28194687003 Ol/Ol/2019 Ol/Ol/2020 EACH OCCURRENCE S S,OOO,OOO V <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $S,OOO,OOO <br /> DED RETENTION <br /> D WORKERSCOMPENSATIONAND WA561os8T8Z6019 Ol Ol/2019 Ol Ol 2020 X PER OTH- <br /> EMPLOYERS'LIABILITY y�N AOS STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1�OOO�OOO <br /> � OFFICER/MEMBEREXCLUDED'+ � NIA wC561168T8z6029 O1�OL�ZO19 OZ�OI�ZO2O <br /> (Mandatory in NH) �,�/2 E.L.DISEASE-EA EMPLOYEE $1,0��,��� <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,OOO,OOO— <br /> � <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required� � <br /> The City of Decatur and its officers and employees are included as Additional insureds in accordance with the policy provisions -`� <br /> of the General Liability and Automobile policies. General Liability and Automobile �iability polices evidenced herein is <br /> Primary and Non-Contributory to other insurance available to an additional Insured, but only in accordance with the policy's � <br /> provisions. A waiver of 5ubrogation is granted in favor of the City of Decatur and its officers and employees in accordance � <br /> with the policy provisions of the General Liability, Automobile Liability, and workers Compensation policies. The Professional <br /> �iability policy has a deductible of $100,000. <br /> � <br /> CERTIFICATE HOLDER CANCELLATION � <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE � <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE �— <br /> POLICY PROVISIONS. <br /> Cl ty Of D2CdtU f Z��l 1101 S AUTHORIZED REPRESENTATIVE �� <br /> #1 Gary K Anderson Plaza F, <br /> Decatur IL 62523 u5a � <br /> �. ��������� � <br /> 01988-2015 ACORD CORPORATIOi�.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />