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Client#: 914933 INTERINC22
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<br /> ACORD CERTIFICATE OF LIABILITY INSURANCE os/DATE(MM/DD/MWDD/ s
<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(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 any rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCERiVAME~V' Uanelle 1 oucnstone
<br /> USI Insurance Services, LLC 11U-b14-2U94 r"" b1U-53/-19U4
<br /> (A/C,No,Ext): (NC,No):
<br /> 7600-C N.Capital of TX Hwy#200 aanelle.touchstonegusi.com
<br /> ADDRESS:
<br /> Austin,TX 78731
<br /> 512 451-7555
<br /> INSURER(S)AFFORDING COVERAGE NAIL N
<br /> INSURER A:Lloyd's of London SURPLU
<br /> INSURED INSURER B:Texas Mutual Insurance Company 22945
<br /> INTERA Incorporated
<br /> 9600 Great Hills Trl INSURER c:Sentinel Insurance Company Ltd. 11000
<br /> INSURER D:
<br /> Suite 300W
<br /> INSURER E:
<br /> Austin,TX 78759
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 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 SUBIF POLICY EFF POLICY EXP
<br /> LTR
<br /> INSR WVD POLICY NUMBER (MM/DO/YYYY) (MM/DD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY ENVP000025426 06/01/2026 06/01/2027 EACH OCCURRENCE $1,000,000
<br /> PREMISES(E
<br /> CLAIMS-MADE I XI OCCUR a oa nr0ence) s300,000
<br /> X GL Ded: $10,000 MED EXP(Any one person) s25,000
<br /> X Poll Ded: $25.000 PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ 52,000,000
<br /> POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
<br /> OTHER: Pollution LI $1,000,000
<br /> C AUTOMOBILE LIABILITY I 65UECZR3402 06/01/2026 06/01/2027 COMBINED)SINGLE LIMIT $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) s
<br /> X HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> A UMBRELLA UAB X OCCUR ENVX000020626 06/01/2026 06/01/2027 EACH OCCURRENCE $6,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $6,000,000
<br /> DED RETENTION$ $ _
<br /> B WORKERS COMPENSATION 0002147146 06/01/2026 06/01/2027 X STATUTE OTH-
<br /> ER
<br /> AND EMPLOYERS'LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Professional Liab ENVP000025426 06/01/2026 06/01/2027 $2,000,000 Aggregate
<br /> $1,000,000 Per Claim
<br /> Retroactive Date 01/10/2002 $100,000 Deductible
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
<br /> The Excess Policy sits over the General Liability,Pollution Liability,Automobile Liability and
<br /> Professional Liability limits.Professional Liability is on a claims made basis.
<br /> The General Liability and Automobile Liability policies include a blanket Additional Insured
<br /> endorsement that provides Additional Insured status to the City of Decatur and its officers and
<br /> (See Attached Descriptions)
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> City of Decatur, IllinoisSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 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 REPRESENTATIVE
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br /> 44#S503253/M54403240
<br /> DDTHZ
<br />
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