R2012-111 AUTHORIZING AN AGREEMENT WITH PHILLIP W. COCHRAN, P.E., ENGINEERING

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DATE(MMND/YYW) CERTIFICATE OF LIABILITY INSURANCE 5/15/2012 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 NAME: KILLAM & ENGLUND INSURANCE PHONE (217)774-3618 (A1Ax No (217) 774-3641 AIC No Ext): C PO BOX 20 AIL killamins@consolidated.net ADDRESS: SHELBYVILLE, IL 62565 PRODUCER i CUSTOMERID#: INSURER(S) AFFORDING COVERAGE NAICN I INSURED o PHIL W COCHRAN ENGINEERING INSURER A:THE HARTFORD INSURER B: 5130 HICKORY POINT FRONTAGE RD INSURER C: DECATUR, IL 62526 INSURER D: INSURER E INSURER F: 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. ILTR TYPE OF INSURANCE ADDL SUOR POLICY EFF POLICY EXP LIMITS INSR VVVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ �GE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE CI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GE_ AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY JEO - LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE _ $ HIRED AUTOS (Per accident) NON-OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X TWC STATU- )TH- AND EMPLOYERS LIABILITYORY LIMITS R '!" 84WECBG8917 10-01-11 10-01-12 7-1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? CI N!A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ , 00 It yes,describe under E.I.DISEASE-POLICY LIMIT $ r r DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF DECATUR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE #1 GARY K ANDERSON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DECATUR IL 62523 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED R R T ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD25(2009/09) The ACORD name and logo are registered marks of ACORD