R2021-221 Resolution Authorizing Laboratory Professional Services Agreement with PDC Laboratories, Inc.

Home Browse Search

ACC)Rb® CERTIFICATE OF LIABILITY INSURANCE r DATE(MMIODN"Y) `*-r 10115/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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. IMPORTAN t: 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 CONTACT Luke Sherman NAME: Insurance Risk Managers PHHOONFEo (217)239-3755 AIC,No: (217)239-3769 2104 Windsor Place ADlAFL siervice@innagencycom Suite B INSURER(S)AFFORDING COVERAGE NAIC# Champaign IL 61820 INSURER A: Crum 9,Forster Specialty Insurance Co 44520 INSURED INSURERS: West Bend Mutual Insurance 15350 PDC Laboratories LLC INSURER C: 2231 Altorfer Or INSURER D: INSURER :INSURER E: Peoria IL 61615 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 Master REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE INSDVIVIDPOLICY NUMBER MIODIYYYY) IMMIDDIYYYYJ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS•MADE FX OCCUR PREMISES tEa occurrence l S 300.000 MED EXP Any one pemom S 25.000 A Y EPK137335 10/01/2021 10/01/2022 PERSONAL&ADV INJURY $ 1,000,000 GENLAGGREGATELIMITA.PPLIESPER, GENERAL AGGREGATE $ 2,000,000 POLICYF_ JECT ®LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Pollution Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLELU S 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Perperscn) S B OWNED SCHEDULED A980758 10101/2021 10/01/2022 BODILY INJURY(Per soddent) S AUTOS ONLY AUTOS , HIRED NON-OWNED PR P R fA S AUTOS ONLY X AUTOS ONLY Wer accidern $ UMBRELLA LIAR I _'ei OCCUR EACH OCCURRENCE $ 5.000,000 A X EXCESS LIAB cLA1Ms MAGE EFX119015 10/01/2021 10/01/2022 AGGREGATE S 5.000,000 DEC) X RETENTION S 0 S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X STATUTE ( HER B ANY PROPRIETORIPARTNERIEXECUT1Vc a N/A A980762 1O/O1i2021 10/01/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE IS 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT Is 11000,000 Professional Liability Occurrence Limit $1.000,000 A EPK137335 10/01/2021 10101/2022 Aggregate Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addldonal Remarks Schedul%may be attached If more apace Is required) Re:South Water Treatment Plant,1155 S Martin Luther King Jr Dr,Decatur,IL 62521 City of Decatur is included as additional insured with respect to general liability,as required by written contract. Excess liability follows form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Decatur ACCORDANCE WITH THE POLICY PROVISIONS. 1 GaryAnderson Plaza AUTHORIZED REPRFSENTATIVE Decatur IL 62523-1196 0198&2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered'marks of ACORD