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BLA2006 OP ID: BF
<br /> CERTIFICATE OF LIABILITY INSURANCE DAT 1012510125D/YYYY)
<br /> /1'1
<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 /> PRODUCERCONTACT
<br /> 217-877-3344 NAME, Becky Fatheree
<br /> J.L.Hubbard Insurance&Bonds —
<br /> 1090 South Route 51,PO Box 14 217-877-0795 (AC,N Ext,7217-877-3344 (i"vc Nor 217-877-0795
<br /> Forsyth, IL 62535.0014 Ao RIESS!
<br /> Kevin J.Breheny bfatheree@jlhubbard.com
<br /> --�—
<br /> INSURER(S)AFFORDING COVERAGE NAIC N
<br /> INSURER A:United Fire&Casualty Company
<br /> INSURED Blank,Wesselink,Cook,&Asso INSURER B;Accident Fund Insurance Co. 110166
<br /> BWC Construction Manager,Inc INSURERC:
<br /> 2623 E, Pershing/POB 2910
<br /> Decatur,IL 62524 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 /> !NSRADDLISUVBD — POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE POLICY NUMBER I A1M1DD,YYY MIAIDDNYYY LIMITS
<br /> GENERAL LIABILITY , EACH OCCURRENCE S 1,000,00
<br /> A MMERCIAL GENERAL LIABILITY I 160353711 11/01111 I 11101112 I PREMISES IEe occurrence) $ _ 100,00
<br /> P—X#C CLAIMS-MADE XI OCCUR I MED EXP(Any one person) $ 5,00
<br /> PERSONAL&ADV INJURY S 1,000,00
<br /> I ! GENERAL AGGREGATE S 2,000,00
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS-COMPIOP AGG $ 2,000,00
<br /> PRO
<br /> POLICYX LOC i $
<br /> 'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT l 1,000,000 Ea occident S -_
<br /> A X ANY AUTO i 60353711 I 11101111 11/01112 BODILY INJURY(Per person) $
<br /> ALL OWNED I SCHEDULED I BODILY INJURY Per acadonl' $
<br /> AUTOS _AUTOS I I l l
<br /> NON•OWNED PROPERTY DAMAGE
<br /> I X HIRED AUTOS X AUTOS I S
<br /> u j 1 Per occidonl'
<br /> ' I
<br /> I$
<br /> UMBRELLA UAB I X OCCUR EACH OCCURRENCE S 1,000,00
<br /> A EXCESS LIAB CLAIMS-MADE 60353711 11!01111 11101!12 I AGGREGATE $ 1,000,00
<br /> DED X RETENTIONS 10000 t $
<br /> WORKERS COMPENSATION WL•STATU• OTH-
<br /> AND EMPLOYERS'LIABILITY YIN X T RY LIMITS ER ]_
<br /> B I ANY PROPRIETOR/PARTNERPcXECUTIVE WCV6025111 11/01/11 11/01/12 E.L.EACH ACCIDENT S 500,00
<br /> OFFICE RIMEMBER EXCLUDED? N NIA1
<br /> ti(Mandatory in NH) ` I E L.DISEASE•EA EMPLOYEE $ 500,05
<br /> (if yes.tlescribo under
<br /> r DESCRIPTION OF OPERATIONS below El DISEASE-POLICY LIMIT $ 500,00
<br /> i
<br /> i
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach AGORD 101,Additional Remarks Schedule,If more space Is required)
<br /> RE: All Work
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> BLA1015
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Decatur ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> #1 Civic Center Plaza
<br /> Decatur,IL 62523 AUTHORIZED REPRESENTATIVE ,
<br /> Kevin J. Breheny - ; F
<br /> ©1988-2010 ACORD CORPORATION. All rightsfBerved,
<br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
<br />
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