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AC RD' TELESCA-02 <br /> �- CERTIFICATE OF LIABILITY INSURANCE DATEiMMIDD/YYYYi <br /> 7/2/2021 <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 <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rl hts to the certificate holder In lieu of such endorsement(s). <br /> PRODUCER cr HOW Schorey <br /> First Mid insurance Group PHONE <br /> 1090 South Route 51 AJC No Ext; 217)859-7047 Ne;217 877.0795 <br /> Forsyth,IL 62535 .hschore tstmid.com <br /> NSURE S FORDINe COVERAGEin <br /> IN UR •Westfield Com antesINSUREDIN U ERB: <br /> Tele Scan,Inc JNSURFRC: <br /> 6275 E Rt 36 <br /> Decatur,IL 62521 I u D:1 SURER EINSURERFCOVERAGES CERTIFICATE NUMBER: REVISION <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 CONTRACTOR 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. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP <br /> POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY LIMITS 1,000,000 <br /> EACH OCCE <br /> GLAIMS MADE OCCUR URR 7/1/2021 7!1/2022 DAMAG siORENTED <br /> )( X 159570Q a) 11000,000 <br /> P An 10,000 <br /> SONAL&ADV INJ $ 1,000,000 <br /> G ML AGGR ATE LIMIT APPLIES PER: EN RAL AGGREGATE 2,000,000 <br /> POLICY JEL4T �LOC PR C P P 2,000,000 <br /> OTHER: <br /> As <br /> AUTOMOBILE LU191LITY COMBINED SINGLE UMI7 S 1,000,000 <br /> X ANY AUTO X 159570Q 7/1/2021 7/112022 <br /> OWNED SCHEDULED BODILY INJ RY Per ti <br /> AURRTE�O�� ONLY AOUTNOpSEp <br /> X AUTOS ONLY X AUTOS ONLY BODILY INJURY eoddent <br /> errant g <br /> A X UMBRELLA UAB X OCCUR URRENCE § 5,000,000 <br /> EXCESS LIAR CLAIMS-MADE 159670Q 711/2021 7/1/2022 GG GAT 5,000.000 <br /> DED X RETENTIONS 0 <br /> A WORKERS COMPENSATION X PER OTH 3 <br /> AND EMPLOYERS•UAFAUTY <br /> ANY PROPRIETOR/PARTNERIEXECUTIVE ��Y.�yJ �, 159632T 7/1/2021 7/112022 A LITE <br /> Q_FFIfeRtoIMFIIABH�EXCLUDED? t NIAE.L. ACCF 1,000,000 <br /> II yes.describe under EL - A YE 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E DISEASE-POU CY LIMIT 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES tACORD 101,AddMlonal Remarks Schedule,may ha attached U,more apace Is required) <br /> EXCLUDED OFFICERS UNDER WORKERS COMPENSATION:John Latshaw <br /> RE:All Work <br /> City of Decatur is named as additional insured under the General Liability and Automobile on a primary basis;subject to written contract <br /> CERT FIC TE HOLDERCANCE TON <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> #1 Gary K.Anderson Plaza ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Decatur,IL 62523 <br /> AUTHORIZED REPR�ESSENTATIVE <br /> ACORD 25(2016/03) M 1988.2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />