R2011-67 AUTHORIZING AGREEMENT FOR PROFESSIONAL SERVICES

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DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE OP ID KA 04/25/11 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: If the certificate holder is an ADDITIONAL INSURED,the po Icy les mus_t%_e_e_n_a_or_s_e77 If SUBROGATION IS WAIVED,su ject 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 UN NAME: KayJacobs Dansig Group P. 0. Box 678 1AIC,No. o Ext: 217-423-3311 (AIC,No): 217-428-876 111 E. Decatur ADDRESS: ka '@cons ociatedansi .corn Decatur IL 62525 CUSTOMERID#: BINDE-1 Phone:217-423-3311 Fax:217-423-3328 iNSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Westfield Insurance Company 24112 Binder Plumbing And Heating, INSURER B: Hastings Mutual Ins. Co. 14176 Inc. & Binder's Forum, Inc. 1975 E. Pershin% Road 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 INSR A ICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY TRA1814008 08/17/10 08/17/11 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $5,000 X "XCUr' X PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X jRO LOC Em Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO TRA1814008 08/17/10 08/17/11 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Par accident) $ SCHEDULED AUTOS X PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ A UMBRELLA LIAB }[ OCCUR TRA1814008 08/17/10 08/17/11 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X , RETENTION $ 0 $ B WORKERS COMPENSATION WC 9614378 08/17/10 08/17/11 _R]TORY LIMITS ER AND EMPLOYERS'LIABILITY Y/N ANY OFFICER/MEMBER EXCLUDED?ECUTIVEr-1 /A E.L EACH ACCIDENT $_500000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500000 A Inland Marine TRA1814008 oe/17/10 08/17/11 Rented Equipment $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule if more space is required) City of Decatur and it's officers and emploees shall be named as additional Insured parties in regards to General liabilyity and Auto Liability covearge. The insurance is provided on a primary and non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYDEC THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Decatur #1 Gary K. Anderson Plaza Cary C. Hise ecatur, IL 62523 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD