R2020-174 Resolution Accepting the Bid and Authorizing the Execution of a Contract with Culy Contracting, LLC for 2020 Annual Manhole Rehabilitation Project, City Project 2020-14

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CULYCO-001 MBAXTER CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/20/2020 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 CONTAE:CT Melissa Baxter NAM VVan Meterinsurance Group PHONE FAX Van Motor Insurance Group (aC,No,Ext):(859)263-2771 (A/c,No)_(859)263-1999 HouchensLexington, tonKY W 3 E-MAIL olic hi usa com ADDRESS:P YG g 5 5 Wellington ton ay I _ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Insurance Comp" 119488 INSUREDINSURER B:AmerisureMutual_Ins_Insurance Com_pany -_ '.23396 Culy Contracting LLC INSURER C: 5 Industrial Park Dr —- PO Box 29 INSURER D Winchester,IN 47394 INSU_RER_E __- INSURER F: COVERAGES CERTIFICATE NUMBER: 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— - ADDLSUBR POLICY EFF POLICY EXP LTR� TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 l CLAIMS-MADE ,OCCUR X CPP21143240001 4/1/2020 4/1/2021 DAMAGE TO RENTED 100,000PREMISE $ S�aoccurrence� X Includes XCLI - 10,000 MED EXP(Any oneperson)__ $ ' PERSONAL&ADV INJURY $ 1000'000 GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY; X PRo X LOC PRODUCTS 2,000,000 _�JECT - ] $ - A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accidentL_ $.__. "ANY AUTO CA21143210001 4/1/2020 4/1/2021 -BODILY INJURY Perperson) $ OWNED SCHEDULED - - AUTOS ONLY AUTOS �'I BODILYINJURPeraccident) $ _.. E� pWN PROPERTY DAMAGE X AUTOS ONLY AUNOS ONLY I'I ._(Per accident) $ HIR X NO I $ B X UMBRELLA LIAB X OCCUR i _EACH OCCURRENCE $ 5'000'000 —� - CU21143220002 4/1/2020 4/1/2021 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED X RETENTION$ 0 PER '�. OTH- AND $ WORKERS COMPENSATION X I STATUTE ER EMPLOYERS'LIABILITY Y I N WC211432300 4/1/2020 4/1/2021 1,000,000 Ai ANY PROPRIMB R/PXCLUD/EXECUTIVE E.L.EACH ACCIDENT $ (Mandatory In NH) ,000,000 E.L.ELDISEASE- EA EMPLOYEE OFFICER/MEMBER EXCLUDED ' N/A If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ II DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule may be attached if more space is required) City Project 2020-14,2020 Annual Manhole Rehabilitation Project.Culy#PC2083i8 Certificate Holder is Additional Insured as respects to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Decatur Illinois #1 Gary K.Anderson PlazaDecatur,IL 62523-1196 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD