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�rospitats�s Certificate of Insurance <br /> Health System <br /> This is i h ' <br /> I to cert fy t at the coverage s listed below are in force at this time and are subject <br />, to the terms, conditions and exclusions as stated in the Hospital Sisters Health System <br /> Self-Insurance Plan documen#. <br /> NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED: <br /> . � <br /> City cf Decab�r, Ill;r�;s <br /> Name and Address of Insured: <br /> • St. Mary's Hospital • <br /> 1800 E. Lake Shore Drive <br /> Decatur, IL 62525 <br /> . <br /> City of Decatur, Illinois is an Additional Insured as is its Mayor, Council Members, O�cers, <br /> Employees and Agents relative to acquisition of portions of Riverside Ave. &Buena Vista Dr. <br /> Combined Single <br /> Limits of Liability <br /> Type of Insurance Expiration Each Occurrence Aggregate <br /> Hospital Professional 07/01/03 $1,000,000 $3,000,000 <br /> Liability <br /> General Liability 07/01/03 $1,000,000 $3,000,000 <br /> Workers' Compensation 07/01/03 Statutory Statutory <br /> CANCELLATION: Should any of the above described coverage's be canceled before <br /> the expiration date thereof, the issuing company will endeavor to mail 30 days written <br /> notice to the above named certificate holder, but failure to mail such notice shall impose <br /> no obligation or liability of any kind upon the company. <br /> DATED: June 21. 2002 BY: � .�/�^ <br /> Dennis W. Taylor <br /> Director, Risk M gement <br /> Hospital Sisters Health System <br />