R2014-145 TEMPORARY CLOSING OF STATE RIGHT-OF-WAY

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YMC2014 OP I D: CST CERTIFICATE OF LI,A BILITY INSURANCE DATE11/122(f1DD/YYYY, 1/14 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 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). CONTACT PRODUCER 217-877-3344 NgME; Crysti Tewell J.L.Hubbard Insurance&Bonds PHONE Fnx 1090 South Route 51,PO Box 14 217-877-0795 (&/G No.Extl:217-877-3344 �A/c No):217-877-0795_ Forsyth,IL 62535-0014 E-MAIL Kevin J.Breheny ADDRESS:ctewell@jihubbard.com INSURER(S)AFFORDING COVERAGE NAIC V INSURERA:West Bend Mutual Insurance 115350 INSURED Young Men's Christian Assoc. INSURER B: of Decatur Matt Whitehead INSURER C 220 W McKinley Ave INSURER D Decatur, IL 62526 INSURER E: INSURER 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 ILTRAtmR TYPE OF INSURANCE POLICYNUMBER i!IM/DDEXP Y/YYYY MhEFF07 DD/YYYY ! LIMITS �GE'NERAL LIABILITY ! I I ( EACH OCCURRENCE ;S 1,000,00( A JC COMMERCIAL GENERAL LIABILITY X INSE2133802 1D/01J1A 10/01/15 DAMAGE DRENT EDI PREMISES Ea occurrence l S 200,00 CLAIMS-MADE OCCUR ( l I ; j MED EXP(Any one person) 5 10,00 1 1 I PERSONAL 8 ADV INJURY S 1,000,00 X 'Cyber Liab i GENERAL AGGREGATE 2,000,00 [GEN,,'L AGGREGATE LIMIT AP�PLIES PER i i j PRODUCTS-COMP/OP AGG I s 2,000,00 POLICY i JFCT PRO- I LOC I I I 5 AUTOMOBILE LIABILITY I COMBINED tt SINGLE LIMIT j Eaac.:den � 1,000,00 A 1 J� ANY AUTO I INS62133802 I 10/01/14 10101/15 BODILYINJURY(Perperson) S —1 ALL OWNED '� SCHEDULED AUTOS AUTOS BODILY INJURY(Per..:.,dent S NON-OI I HIRED AUTOS I AUTO' i I PROPERTY DAMAGE S r_ll I (Per accident) X ;UMBRELLA LIAB X l OCCUR EACH OCCURRENCE S 5,000,00 A I—~EXCESSL1AflCLAIMS-MADEI INUB2133803 I 10/01114 10101/15 AGGREGATE S,OOO,DO DED 1 X I RETENTIONS Waived, I WORKERS COMPENSATION i X WC STATU- i ;OTH-, AND EMPLOYERS'LIABILITY YIN I , l TORY LIMITS ER 1 A ANY PROPRIETORIPARTNER/EXECUTIVE I SCB2133804 10/01114 10/01/15 E.L EACH ACCIDENT S 500,00 OFFICER/MEMBER EXCLUDED) � N/A I (Mandatory in NH) I I I E L DISEASE-EA EMPLOYEE!S 500,D0 i If yes describe under i DESCRIPTION OF OPERATIONS balm-, I E L DISEASE-POLICY LIMIT S 500,00 l I I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) RE: 2 Miles to Miles event - 12/31/14; Alternate date of 02/22/15. The City of Decatur and the State of Illinois are named as Additional Insureds under the General Liability. Form NS0018 applies. I CERTIFICATE HOLDER CANCELLATION YMCA001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Decatur ACCORDANCE WITH THE POLICY PROVISIONS. Linda Swartz 1 Gary Anderson Plaza AUTHORIZED REPRESENTATIVE Decaur, IL 62523 . -s.�� O 11988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD