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DATE(MMIDDIYYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE
<br /> 12/13/2010
<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(ies) 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 CONTACT Trac Beville
<br /> NAME: y
<br /> Professional Concepts Insurance PHONE . (800)969-4041 A1C No:(800)969-4081
<br /> 1127 South Old US Highway 23 ADORess:tbeville@pciaonline.com
<br /> PRODUCERCUST p0001460
<br /> Brighton MI 48114-9861 INSURER(S)AFFORDING COVERAGE NAIC III
<br /> INSURED INSURER A.Hartf ord Casualty Insurance CO 29424
<br /> INSURER B-.Hartford Underwriters Ins. Co. 30104
<br /> Carl Walker, Inc. INSURERCXL Specialty Ins. Co. 37885
<br /> 5136 LOVERS IN, STE 200 INSURER D:
<br /> Suite 200 INSURERE:
<br /> KALAMAZOO MI 49002 INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER•,All 10/11 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 /> INSR TYPE OF INSURANCEADDLISUEIR POLICY EFF POLICY EXP LIMITS
<br /> LTR INR WVD POLICY NUMBER MM/DDIYYYY MMIDD
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> DA—MAGE TRENTED 300,000
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $
<br /> A CLAIMS-MADE XIOCCUR 35SBWRU0693 2/31/2009 2/31/2011 MED EXP(Any one person) $ 10,000
<br /> X X,C,U 35SBWU12279 PERSONAL 8 ADV INJURY $ 1,000,000
<br /> X Contractual Liability GENERAL AGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> POLICY PROJECj LOC
<br /> X $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br /> (Ea accident)
<br /> ANY AUTO BODILY INJURY(Per person) $
<br /> B ALL OWNED AUTOS 5UEGAF3505 2/31/2009 2/31/2011
<br /> BODILY INJURY(Per accident) $
<br /> X SCHEDULED AUTOS PROPERTY DAMAGE $
<br /> X HIRED AUTOS (Per accident)
<br /> X NON-OWNED AUTOS PIP-Basic $
<br /> Uninsured motorist combined $ 1,000,000
<br /> X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> DEDUCTIBLE $
<br /> A X RETENTION $ 10,000 35XHGXY9736 2/31/2009 2/31/2011 $
<br /> A WORKERS COMPENSATION XI WC STATU- OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> ITO LIMITER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICERIMEMBER EXCLUDED? � NIA 2/31/2009 2/31/2011
<br /> (Mandatory In NH) SWEGPN3645 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 DPR9689186 0/15/2009 0/15/2011 $2,000,000 perdlaim
<br /> $2,000,000 aggregate
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is recpilred)
<br /> The City of Decatur and its officers and employees shall be named as additional insured parties on the general
<br /> liability policy and included as additional insured parties on the automobile liability policy so long as required
<br /> within a written contract. The City's interests as additional insured parties shall be on a primary and
<br /> non-contributory basis on all policies and noted as such on the insurance certificates. 30-Day Prior Notice of
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> City of Decatur, Illinois
<br /> #1 Gary K. Anderson Plaza
<br /> Decatur, IL 62523 AUTHORIZED REPRESENTATIVE
<br /> Mike Cosgrove/DES �`�u`�ACORD 25 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved.
<br /> INS025(200909) The ACORD name and logo are registered marks of ACORD
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