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/`fC 0 DATE(MWDDNYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 11/23/2021
<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(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER 1-800-527-9049 CONTACT
<br /> NAME: Linda Bomarito
<br /> Holmes Murphy and Associates PHONE FAX
<br /> - Peoria C N M: 309-282-3903 AIC No: 866-501-3945
<br /> E-MAIL LBomarito@holmesmu h
<br /> 311 S.W. Water Street ADDRESS: rP Y•com
<br /> Suite 211 INSURERS AFFORDING COVERAGE NAIC#
<br /> Peoria, IL 61602-4108 INSURER A: EMPLOYERS MUT CAS CO 21415
<br /> INSURED INSURER B: XL SPECIALTY INS CO 37885
<br /> Crawford, Murphy & Tilly, Inc.
<br /> INSURER C: COLONY INS CO 39993
<br /> CMT North America, Inc.
<br /> 2750 West Washington INSURER D:
<br /> INSURER E:
<br /> Springfield, IL 62702 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 63826666 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.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICPOLICY EXP
<br /> LTR POLICY NUMBER MMIDDY EFF MM/DD LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY 5D57480 01/01/21 01/01/22 EACH OCCURRENCE $ 1,000,000
<br /> DAMAG
<br /> E TONTED
<br /> CLAIMS-MADE OCCUR PREM SES EaEoccu encs $ 1,000,000
<br /> X Sev of Int MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> POLICYjE F ] LOC
<br /> ril PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: Valuable Papers $ 1,000,000
<br /> • AUTOMOBILE LIABILITY 5E57480 01/01/21 01/01/22 COEa ccidentMBcid.ml SINGLE LIMIT $ 1,000,000
<br /> a
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNEDSCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> X HIREDX NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> A X UMBRELLALIAB X OCCUR 5J57480 01/01/21 01/01/22 EACH OCCURRENCE $ 10,000,000
<br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> DED I X I RETENTION$ 101000 $
<br /> A WORKERS COMPENSATION 5H57480 01/01/21 01/01/22 X I PER STATUTE ETH
<br /> AND EMPLOYERS'LIABILITY
<br /> YIN ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBEREXCLUDED? 1,000,000
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> B Professional Liability DPR9970352 01/01/21 01/01/22 $5m Each Claim 7mAggregate
<br /> C Pollution Liability F, CSP4223613 01/01/21 01/01/22 $2m Each Claim 2mAggregate
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required)
<br /> PROJECT : SWTP EAST CLARIFIERS CONVERSION CITY PROJECT 2016-03
<br /> CITY OF DECATUR IS NAMED AS ADDITIONAL INSURED ON THE GENERAL LIABILITY, AUTO
<br /> LIABILITY, AND UMBRELLA LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT PER POLICY
<br /> TERMS AND CONDITIONS.
<br /> A 30 DAY NOTICE OF CANCELLATION APPLIES TO THE GENERAL LIABILITY, AUTO LIABILITY,
<br /> UMBRELLA LIABILITY, AND WORKERS COMPENSATION AS REQUIRED BY WRITTEN CONTRACT
<br /> PER POLICY TERMS AND CONDITIONS.
<br /> CERTIFICATE HOLDER CANCELLATION
<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 /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> #1 GARY K ANDERSON PLAZA AUTHORIZED REPRESENTATIVE
<br /> DECATUR, IL 62523
<br /> USA
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
<br /> AR070002
<br />
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