R2011-68 AUTHORIZING AN AGREEMENT WITH TELE SCAN, INC.

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4�Ze CERTIFICATE OF LIABILITY INSURANCE OP ID TM [7ATE(MMIDO/YYYY) 04/21/11 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: the certificate holder is an ADDITIONAL INSURED,the po icy ies must be endorsed. ED,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). PRODUCER NAME; Trenda Myers HONE FAX J.L.Hubbard Insurance & Bonds Arc No E:c: 217-877-3344 A/C No): 217-877-079 1090 South Route 51, PO Box 14 ADDRESS: tm ers@ 'lhubbard.com Forsyth IL 62535-0014 cusrU1.;LK #: TEL2000 Phone:217-877-3344 Fax:217-877-0795 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: United Fire & Casualty Company Tele Scan, Inc INSURER B: accident Fuad Inaurance Co. 10166 6275 E Rt 36 Decatur IL 62521 INSURERC: 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 60349383 07/01/10 07/01/11 PREMISES Ea Occurrence $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,000 X PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 X POLICY E jECT LOC Emp Ben. $ 1 mil AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT dent) $ 1,000,000 A X ANY AUTO 60349383 07/01/10 07/01/11 BODILY BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS X PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ A UMBRELLA LIAB X OCCUR 60349383 07/01/10 07/01/11 EACH OCCURRENCE s2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s2,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION WCV6021643 07/01/10 07/01/11 AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED? y I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5 0 0 0 0 0 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Decatur is named as additional insured under the general liability and automobile liability, subject to written contract. CERTIFICATE HOLDER CANCELLATION TEL2 0 07 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Decatur AUTHORIZED REPRESENTATIVE #1 Gary K. Anderson Plaza Kevin J. Breheny Decatur IL 625232. ©1988-2009 ACOR ORATIO . All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD