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AcORd- DATE(MM1DDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 10/9/2025 <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 CONTACT <br /> NAME: <br /> CCMSI PHONE FAX <br /> c/o Cannon Cochran Management Services,Inc. IA/C.No.Exu:(800)-252-5059 1216 (A/C,No): <br /> E-MAIL ccsfire uests ccrosi.com <br /> Towne Centre Building _ADDRESS: 9 <br /> 2 East Main Street INSURERS)AFFORDING COVERAGE N_AIC <br /> Danville,IL 61832 INSURER A;CONSOLIDATED CONSTRUCTION SAFETY FUND OF ILLINOIS <br /> INSURED INSURER e: <br /> HENSON ROBINSON COMPANY <br /> PO BOX 13137 INSURER C: <br /> SPRINGFIELD,IL 62791 INSURER D: <br /> INSURER E: <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 ADDL.SUER POLICY EFF I POLICY EXP <br /> LTR TYPE OF INSURANCE (NSD WILD POLICY NUMBER (MM/DO/YYWI'(MMIDDIYYYYI LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES(Ea occurrence) $ <br /> MED EXP(Any one person) S <br /> PERSONAL R ADV INJURY S <br /> OENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ <br /> POLICY JJEE•CT LOC PRODUCTS-COMP/OP AGG <br /> OTHER: <br /> AUTOMOBLEIJAEIUTY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY _ AUTOS ONLY istffit (Per accident) _ <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB ^— CLAIMS-MADE / '+ AGGREGATE $ <br /> DED RETENTIONS _ p7 $ <br /> WORKERS COMPENSATIONX PEATUTE ERH <br /> AND EMPLOYERS'UABIUTY <br /> A OFFICER/MEMBEREXCUDED?ECUTIVE Y Ii N I A WC00200030125 12/31/2025 12/31/2026 El.EACH ACCIDENT S 2,000,000 <br /> (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 2,000,000 <br /> Byes,desc ioe miler 2,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> PROJECT 2022-02 AND 2022-16, CHEMICAL FEED UPGRADES AND BULK WATER UPGRADE,HRC#30156-364 <br /> ALL WORK /ADDITIONAL INSUREDS DOES NOT APPLY TO WORKERS COMPENSATION/30 DAY WRITTEN CANCELLATION NOTICE <br /> SAFETY NATIONAL PROVIDES EXCESS W/C INSURANCE IN EXCESS OF PROGRAM RETENTIONS <br /> Excluded Officer(s):BRIAN VOGT SEC/TREASURER; <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITY OF DECATUR ILLINOIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> #1 GARY K.ANDERSON PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> DECATUR,IL 62563-1196 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CertRecID:736442 <br /> PRID:349113018 <br />