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<br /> A CERTIFICATE OF LIABILITY INSURANCE D06/20/DD/YYYY)
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<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 I
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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 CONTACT
<br /> Holmes Murphy and Associates PHONE F
<br /> - Peoria
<br /> AIC No
<br /> 311 S.W. Water Street -NAIL
<br /> Suite 211 DRESS:
<br /> Peoria, IL 61602-4108 INSURERS AFFORDING COVERAGE NAIC0
<br /> Paula Dixon INSURER A; CHARTER OAK FIRS INS CO 25615
<br /> INSURED INSURER B: TRAVELERS IND CO 25658
<br /> Bainbridge, Gee, Nilanski & Associates
<br /> INSURER C: TRAVELERS CAB & SURETY CO 19038 '
<br /> 1670 Taylorville Road INSURER D;
<br /> Decatur, IL 62521 INSURER E:
<br /> INSURER F:
<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 I
<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 /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i
<br /> ITR TYPE OF INSURANCE POLICY NUMBER MMIDDmFF MMIDD
<br /> FXP
<br /> ELIMITS
<br /> A GENERAL LIABILITY 686274BL565 07/09/1 07/09/13
<br /> EACH OCCURRENCE $
<br /> 1,000,000
<br /> % COMMERCIAL GENERAL LIABILITY PREMISES ATO $1,000,000
<br /> CLAIMS-MADE a OCCUR MED EXP one person $10,000
<br /> PERSONAL 4 ADV INJURY $1,000,000
<br /> GENERALAGGREGATE $2,000,000
<br /> GE N'L AGOREOATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $2,000,000
<br /> POLICY X PRO-iEcT X LOC $
<br /> B AUTOMOBILE LIABILITY BA274OL332 COMBINED SINGLE LIMIT
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<br /> ANY AUTO BODILYdINJURY(Perperson) $1,000,000
<br /> AALLLL OOSNED SCTOEBDULED BODILY INJURY(Per sodden) $
<br /> HIRED AUTOS X AUTOS
<br /> SOWNED PPReOPERT DAMAGE $
<br /> $
<br /> H X UMBRLILALWB X OCCUR CUP6745Y549 07/09/1 07/09/13 EACH OCCURRENCE $1,000,000
<br /> EXCESS LIAR CLAIMS-MADE
<br /> AGGREGATE $1,000,000
<br /> DEC) X RETENTION 10,000 $
<br /> B WORKERS COMPENSATIONYIN UH6745Y353 07/09/1 07/09/13 % WeSTATU- OTH.
<br /> AND eWLOYERS'LIABILnYTORY I uIrrs ER
<br /> ANY PROPRIETORIPARTNERIEXECU71VE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? Fil N I 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 /> C Professional Liability 105304894 07/09/1, 07/09/13 Sach Claim 2,000,000
<br /> Claims Made Aggregate 2,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addticnal Remarks Schedule,If more space Is required)
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<br /> CERTIFICATE HOLDER CANCELLATION
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<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 /> Decatur, IL 62523
<br /> USA
<br /> m 1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br /> tstoeckeril
<br /> 27984429 i
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