R2021-184 Resolution Accepting the Bid and Authorizing the Execution of a Contract with Culy Contracting LLC for 2021 Manhole Rehabilitation Project, City Project 2021-14

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CULYCO-001 MBAXTER ACOR/�° CERTIFICATE OF LIABILITY INSURANCE DAT128/2D/Y 9/28/2021 1 ' 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(les)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 C NTACT Melissa Baxter Van Meter Insurance Group PHONE FAX Houchens Insurance Group IA/c,No,Ext):(859)263-2771 (ANC,No):(859)263-1999 505 Wellington Way E-MAIL •policy@higusa.com Lexington,KY 4053 INSURERS AFFORDING COVERAGE NAIC# ' INSURERA:Amerisure Insurance Company 19488 INSURED INSURERB:Amerisure Mutual Insurance Company 23396 Cult'Contracting LLC 5 Industrial Park Dr INSURERC:AGCS Marine Insurance Company 22837 ' PO BOX 29 INSURER D: Winchester,IN 47394 INSURER 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS ' TYPE OF INSURANCE POLICY NUMBERDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE (OCCUR X CPP21143240101 4/1/2021 4/1/2022 DAMAGE TOaENTED S 100,000 X Includes XCU MED EXP(Any oneperson) $ 10,000 ' PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY aX YECOT I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 ' OTHER: g A AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ 1,000,000 X ANY AUTO CA21143210101 4/1/2021 4/1/2022 BODILY INJURY Perperson) S OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUpTOSWN R ' X M� ONLY X AUTO ONLY PPerracudent AMAGE $ $ B X UMBRELLA LIAR [I OCCUR EACH OCCURRENCE S 5,000,000 ' EXCESS LIAB CLAIMS-MADE CU21143220102 4/1/2021 4/1/2022 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 $ A WORKERS COMPENSATIONX SPTATU OTH- AND EMPLOYERS'LIABILITY YIN T ANY PROPRIETOR/PARTNER/EXECUTIVE C211432301 4/1/2021 4/1/2022 1,pOQ,Qpp FFICERIMEMBER EXCLUDED? � N/A E.L.EACH ACCIDENT $ ' Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Inland Marine MZ193085371 4/1/2021 4/1/2022 Leased/Rented Equip 150,000 C Installation Floater MZ193086371 4/1/2021 4/1/2022 Ded$1,000 150,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES iACORD 101,Additional Remarks Schedule,may be attached if mores ace Is required) Project Name:2021 Manhole Rehabilitation Project,City Project 2021-14 Job number:PC218270 Project Location:Decatur IL Certificate Holder is Additional Insured in regards 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 PlazaIDecatur.IL 62523 1pol ' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. ' The ACORD name and logo are registered marks of ACORD