R2022-107 Resolution Accepting the Bid and Authorizing the Execution of a Contract with Microsurfacing Contractors, LLC City Project 2022-24

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' 7 ® DATE(MM/DD/YYYY) A6 o;L CERTIFICATE OF LIABILITY INSURANCE 7/1/2022 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 NAMEA T Sandy Miller Kuhl Insurance Agency, Inc. PHONE FAX 632 West Jefferson C o Ext):309-266-7300 A/c No:309-266-5453 Morton IL 61550-0066 ADDRESS: smiller@kuhlinsurance.com INSURFRISI AFFORDING COVERAGE NAIC# INSURER A:QBE Insurance Group 11515 INSURED INSURER B:Encova Insurance Agency Inc. 13331 Microsurfacing Contractors LLC INSURER C:The Burlington Insurance Coma 23620 13940 St Charles Rock Rd Bridgeton MO 63044 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2135841675 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 ADDLTYPE OF INSURANCE K$k SUBR POLICY NUMBER MMI DffYYYY MM%DfYYYY LICY EFF POLICY EXP LIMITS LTR LT A X COMMERCIAL GENERAL LIABILITY Y Y CC11329712 1/31/2022 1/31/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 1K OCCUR DAMAGE TO RENTED 100,000 X PREMISES Ea occurrence $ MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 jE O- �LOC PRODUCTS-COMPIOP AGG $2,000,000 POLICY a OTHER: A AUTOMOBILE LIABILITY Y Y CBA1329712 1/31/2022 1/31/2023 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident C X UMBRELLA LIAB X OCCUR Y Y 3516E00941 1/31/2022 1/31/2023 EACH OCCURRENCE $7,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I X I RETENTION$ $ B WORKERS COMPENSATION Y WCP7001133 1/31/2022 1131/2023 X I PER STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNERIEXECUTIVEN/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUD ED? FYI (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,descr be under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A Leased/Rented Equip CC11329712 1/31/2022 1/31/2023 All perils 500,000 E L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) City Project 2022-24,Microsurfacing Project The City of Decatur and City Project 2022-24,Microsurfacing Project are added as additional insureds under the General Liability policy. 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. City of Decatur #1 Gary K Anderson Plaza AUTHORIZED REPRESENTATIVE Decatur IL 62523-1196 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD