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<br /> ,acc OR ® CERTIFICATE OF LIABILITY INSURANCE D06/28/DOIY
<br /> o6/aH/aol2
<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 be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER 1-800-527-9049 TACT
<br /> Holmes Murphy and Associates PHONE FAX
<br /> - Peoria (AIC,No.
<br /> 311 S.W. Water Street •MAIL
<br /> Suite 211 ARDRESS:
<br /> Peoria, IL 61602-4108 INSURERS AFFORDING COVERAGE NAIC1l
<br /> Paula Dixon INSURER A: CHARTER OAR FIRE INS CO 25615
<br /> INSURED INSURER B; TRAVELERS IND CO 25658
<br /> Bainbridge, Gee, Milanski & Associates
<br /> INSURER C; TRAVELERS CAS & SURETY CO 19038
<br /> 1670 Taylorville Road INSURER D:
<br /> Decatur, IL 62521 INSURER E:
<br /> INSURER F: T
<br /> COVERAGES CERTIFICATE NUMBER: 27984429 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 I
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> AD SUBM
<br /> NN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br /> ILTR TYPE OF INSURANCEOUCY EXP
<br /> Wvn POLICY N MBER M LICDY EFF MM/DD LIMITS
<br /> A GENERAL LIABILITY 690274BL565 07/09/1 07 09/13 EACH OCCURRENCE $1,000,000
<br /> % COMMERCIAL GENERAL LIABILITY $1,000,000
<br /> CLAIMS-MADE M OCCUR MED EXP Any one ereon $10,000
<br /> PERSONAL 8 ADV INJURY $1,000,000 !
<br /> GENE RALAGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000
<br /> POLICY MPRO X LOC $
<br /> B AUTOMOBILE LIABILITY BA2740L332 COMBINED SING E
<br /> E eoddent) 1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED II
<br /> AUTOS AUT08 BODILY INJURY(Per aoddent) $
<br /> X HIRED AUTOS Ix
<br /> AUTOS
<br /> D PROPER DAMAGE $ i
<br /> Per
<br /> H X UMBRELLALIAB X OCCUR CUP6745YS49
<br /> 07/09/1 07/09/13 EACH OCCURRENCE $1,000,000 i
<br /> EXCESS LIARCLAIMS MADE
<br /> AGGREGATE $1,000,000
<br /> DED X JRETENTION$10,000
<br /> B WOR
<br /> KERBCOMPENSATION UB6745Y353 07 0 WCSTATU- 17O
<br /> TH- $
<br /> ANDEMPLOYERS'LIASIUTY YIN 07/09/1 / 9/13 %
<br /> ANY PROPRIETOR/PARTNERIEXECUTIVE
<br /> OFFICER/MEMBER EXCLUDED? [N N/A E.L.EACH ACCIDENT $ 1,000,000
<br /> (Mandatory In NH)
<br /> E.L.DISEASE-EA EMPLOYE $ 11000,000
<br /> If yea,tlIPTIONeacilbe under E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> DESCRIPTION OF OPERATIONS below
<br /> C Professional Liability 105304894 07/09/1, 6-776-971-3 Eaoh Claim 2,000,000
<br /> Claims Made Aggregate 2,000,000
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<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
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<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE !
<br /> City of Decatur THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Richard G. Marley
<br /> #1 Gary X Anderson Plaza AUTHORIZED REPRESENTATIVE
<br /> 1
<br /> Decatur, IL 62523
<br /> USA P
<br /> m 1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br /> totoeckeril
<br /> 27984429
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