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,.��'� CHA2015 OP ID: HS <br /> A�o�R'�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY);t <br /> 12122I2015 �� <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFQRMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS' <br /> CERTIFICATE dOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND QR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CpNTRACT BETWEEN THE ISSUING INSURER(S), AUTMORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPQRTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, sub}ect 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 /> certiflcate holder In lieu of such endorsement s). <br /> PRODUCER CONTACT }.,��III SCF10P9 <br /> J.L.Hubbard insurance&Bonds NAME: <br /> 1490 South Route 51, PQ Box 44 PHONE 217_877_33� a��, Z17-877-0795 �� <br /> Forsyth, IL 62636-0014 ADDRIE55;f13CI101'@ Ihubbard.com � � <br /> Daniel A.Martini <br /> INSURER S AFFOFtDING COVERAGE NAIC p- <br /> INSURERA:TI7G CIf1CIt1�18tI IIlSU1'8�1C@ �Os]7 <br /> INSURBD Chastain&Associates LLC �r,suReRe;Accident Fund Insurance Co. 10166 ! <br /> 5 N Country Club Rd <br /> Decatur, IL 62521 INSURERC: <br /> INSURER D: <br /> INSURER E: , <br /> IN9URER F: - � i <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF WSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOV�FOR THE POLICY PERIQp <br /> INDICATED. NOTWITHSTANaING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHEft DOCUMENT WITH RESPECT T�WHICH TNIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TH6 POLICfES 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 /> �LTR NpE OFlN3URANCE POLICY NUMBER MM/DDlYYYY MMIDDnYYY ` LIMITS � <br /> A X COMIIERCIALGENERALLIABILITY EACHOCCURRENCH $ 'I,OOO�QQ <br /> CLAlMS-MAPE � OCcuR X EPP0291693 Q110112016 0110112017 E � E Eao�ccu ance g 300,00 <br /> -;;r <br /> MER EXP(An one person) $ 10„400 <br /> PERSONAL 6 ADV INJURY $ 'I,OOO�OOO <br /> GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ Z,OOO,aao <br /> POLlCY�jECT � LOC <br /> PRODUCTS-COMPlOPAGG $ 2,OOO,QO <br /> OTHER: S <br /> AUTOMOBILE LlABII.ITY �CptvIBINED SINGLE LtMIT - <br /> _�Eaacci��__ S 1,000,040 <br /> A X ANY AUTO X EBA0291693 0110112018 0�10�/2�17 BapILY INJURY(Per person) S • <br /> ALL OWNED SCHEDULE� 60DILY INJURY Per eccidant $ <br /> AIITOS AUTpS ( 1 <br /> HIREp AUTOS NON•OVVNED PROPERTY QAMAGE $ <br /> AUTOS Per accident <br /> -----$ <br /> X UMBREGLA LIAB X OCCUR EACH OCCURRENCE $ B4OOO,OO <br /> A EXCESS LIpB CtAIMS-MADE EPPQ291693 ��/Q�/2016 01101/2017 qGGREGA7E $� 6,���,0�� <br /> DE6 X RETENTION S 0 ` $ <br /> WORKERS COMPENSATION X ER H- <br /> AND BMPLOYERS'LIABILIT7 STATUTE ER � <br /> 8 AIVY PROPRIETORlPARTNER/EXECUTIVE Y�N CV6107018 OT/0�/2��6 01/01/2017 E,L.EACM ACCIDENT S �,��Q,�� <br /> OFFVCERlPAE�ABER EXCLUDED? N� N 1 A —� <br /> (MandatorylnNH) E,L.DISEASE-EAEMPLOYEE $ 1,0�0,�0 <br /> If yes,describe under <br /> DESCRIPTION OF OPER.4TIONS below E.L DISBASE-POLICY LIMIT $ ��O00,04 <br /> I <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VENICLES (ACOR�101,Addltlonal Remarks Schedule,may be attachod ii moro space le requlred) <br /> Re:All Work <br /> The CIty of Decatur and its officers and Employees are named as additional .; <br /> insurecfs under the General Liability and Automobile on a primary and non- . ��^ <br /> contributory basis;subject to written conEract. :'• <br /> CERTIFICATE HOLDER CANCELLATfON - <br /> CHAS021 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 9E CANCELLED BEFOR� <br /> THE EXPIRATION DATE THEREOF, NOTICE WI[,L BE pELIVERED IN <br /> Clt}I Of D@C8tU1'� ACCORDANCE WITH THE POLICY PROVISIONS, <br /> 1 Gary K Anderson Plaza <br /> Decatur, IL 62523 AUTHORIZED R�E`PRESENTATNE <br /> �'",-*.t,�.+�����., <br /> �O 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACOf2p <br />