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,,��� TEL2000 OP iD: HS <br /> ACOR� DATE�MM/DDlYYYY� <br /> `,_,, CERTIFfCATE QF LIABILITY INSURANCE p6/22/15. <br /> TH{S CERTtFiCATE IS ISSUED A3 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 /> REPRESENTATIYE OR PRODUCER,AND THE CERTIFtCATE HOLDER. <br /> IMPORTANT: if the certiflcate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATfON IS WAIVED,subJect to <br /> the terms and conditions of the policy,certaln policies may requfre an endorsement A statement on this certificate does not confsr rights to the <br /> certiflcate holder in lieu of such endorsement s. <br /> PRODUCER C NTACT <br /> 217-877-3344 Nn�,e: Holli Schore <br /> J.L.Hubbard Insurance 8 Bonds 217.g�7-07g P►�oME .297-877-334� nic No: 217-877-0795 <br /> 1090 South Route 5'1,PO Box 14 c E . _ <br /> Forsyth,IL 62535-0014 Ao�E�;hschore 'ihubbard.com <br /> Daniei A.Martini — <br /> INSURER S AFFOROING COVERAOE NAIC M <br /> INSURER A:Ufll�Flf@ 8c C8S118I Com n 13021 <br /> INSURED Tele Scan,�flC INSURER B:�f�C�@ Net Underwriters <br /> 6275 E Rt 36 <br /> �@C8tU1'�IL 62521 INSURER C: <br /> INSURER p; <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISfON NUMBER: <br /> THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE iNSUftED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY RE�UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCIiMEN7 WI7H RESPECT TO WHICH THlS <br /> CERTIFICATE AAAY $E ISSUED OR MAY PERTAIN, THE lNSURANCE 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 /> ��7R TYPE OF WSURANCE PpLICY NUMB£R MM�I/uDD/YYr� M�M/LDDlYYYY � LIMRS <br /> GENERAL UAStt.RY EACH OCCURRENCE S ��OOO,OO <br /> .4 X COA+�tERCIAI GENERAL LIABtLITY X 60349383 07/0���5 07/01116 pREMISES Ea occurtance 3 3Q0�0 <br /> CLAq4tSaNADE �OCCUR MED EXP(My one peraon) E �O�OO <br /> PERSONAL 8 ADV INJURY 3 'I�OOO,O <br /> GENERAL AGGREGATE = Z,OOO,OQ <br /> GEN'L RGC3RE�ATE LfMIT RP?EtES PER'. PP,ODUGTS-COPRP/OP AQ6 $ �L,OOO, <br /> POLICY X PRO- �oc Emp Ben. a 1M l <br /> AVTOMOBILE LIABILITV E�t�SINGLE IIMIT ,��O�ro <br /> A X ANY AUTO X 60349383 07I01/15 07J01/16 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AU705 X NON-OWfJED PROPERTY DAMAGE $ <br /> AUTOS Per accideni <br /> $ <br /> X UMBRELUI LIAB X OCCUR EACH OCCURRENCE S S,OOO,OO <br /> A EXCESS Lwe CLAIMS-MADE 60348383 07/01/15 �7l01116 A�REGATE S rJ,0�0, <br /> oea X RETENTlON i 10 000 g � ' <br /> WORKERS COAitPENSATiON X VNC STATU- X OTN- I <br /> AND EMPLOYERS'UA&UTY <br /> B ANYPROPRIETOR/PARTNEWE)CECUTIVE Y!N gNUVItC0120753 O7/O'IHS O7/O'INB EL.EACHACCIDENT S �,OOO� <br /> OFFICER/MEMBER EXCLUOED7 � N�A --- � — <br /> (Msndatory in NH) E.L.DISEASE-EA EMPIOVEE S �,0��,� <br /> N Yes.desaibe under <br /> DESCRtPTiON OF OPERATtONS below E.L DISEASE-POLiCY LNUi1F $ �,OOO O <br /> DESCRiPT10N OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORO 701,AWAqonal Remarka Schatluta,if more spaco is required) <br /> RE: All Work <br /> City of Decatur is named as additionsl insured on a primary basie under the <br /> General I.iability and additional insured under the Automobile; subject to <br /> written contract. <br /> CERTIFICATE HOLQER CANCELLATION <br /> TEL2007 ` <br /> SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE �LIVERED IN <br /> ACCORDANCE WRH THE POLICY PROYISIONS. <br /> City of Decatur <br /> #1 Gary K.Anderoon Plaza <br /> Decatur, IL 62523 AUTHORIZED REPRESENTATIVE <br /> ������ <br /> �O 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25�2010/OS) The ACORD name and logo are regisbered marks of ACORD <br />