R2024-354 Resolution Authorizing an Agreement with Tele-Scan, Inc. for the Annual Sewer Inspection Program, City Project 2025-19

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TELESCA-02 JSTPIERRE ACOR© DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/4/2024 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(ies)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 Jenifer St.Pierre First Mid Insurance GroupP IC, E. Ext):(217)859-7068 (A//CC,No): 1090 South Route 51 Forsyth,IL 62535 EA-pmpA4LE$s:jenifer.stplerre@firstmid.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:West Bend Insurance Company 15350 INSURED INSURER s:AmTrust 15954 Tele Scan, Inc INSURER C: 6275 E Rt 36 INSURER D: Decatur,IL 62521 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 LTR TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE OCCUR X B696356 7/1/2024 7/1/2025 DAMAGE TO RENTED occurrence) 1,000,000 MED EXP(Any oneperson) 5'000 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2'000'000 POLICY❑X JEef FX LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINEDtSINGLE LIMIT 1,000,000 X ANY AUTO X B696356 7/1/2024 7/1/2025 BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident X HIRED X NON-OWNED PerOPERTYtDAMAGE AUTOS ONLY AUTOS ONLY ac A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5,000,000 EXCESS LIAB CLAIMS-MADE B696356 7/1/2024 7/1/2025 AGGREGATE 5'000'000 FiDED X RETENTION$ 0 B WORKERS COMPENSATION X PER OE'F AND EMPLOYERS'LIABILITY STATUTE TWC4459695 7/1/2024 7/1/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1'000'000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES `ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) EXCLUDED OFFICERS UNDER WORKERS COMPENSATION:John Latshaw RE:Annual Sewer Inspection Program,2025-2027-City Project 2025-19 City of Decatur and its officers and employees are named as additional insured under the General Liability and Automobile on a primary noncontributory basis;subject to written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. #1 Gary K.Anderson Plaza Decatur, IL 62523 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD