R2016-138 Contract with Felmley-Dickerson Fire Station Renovation CP 2016-11

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108230 DATE(MMIDD/YYYY) ARV® CERTIFICATE OF LIABILITY INSURANCE 11/28/2016 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 policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject 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 CONTACT NAME: Ackerman Commercial Lines-(217)398-4400 PHONENo Ext: AIC No); 217-398-4400 FAX 877-302-2930 C Wells Fargo Insurance Services USA,Inc. E-MAIL ton ackerman@wellsfar ADDRESS: y o.com g 2107 S.Neil Street INSURER(S)AFFORDINGCOVERAGE NAIC# Champaign,IL 61820-2071 INSURERA: Cincinnati Insurance Company 10677 INSURED INSURER B Felmley-Dickerson Co. INSURER C: PO Box 1550 INSURER D: INSURER E: Bloomington,IL 61702-1550 INSURER F: COVERAGES CERTIFICATE NUMBER: 11128788 REVISION NUMBER: See below 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X X EPP0033171 08/01/2016 08/01/2017 _ CLAIMS-MADE �OCCUR DAMAGE— TOTED 500,000 PREMISES Ea occurrence $ X includes x,c and u MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY II ECT F7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S A AUTOMOBILE LIABILITY EBA0033171 08/01/2016 08/01/2017 Ea aCOMBINEDtSINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIREDX NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident $ A x UMBRELLALIAB X OCCUR EPP0033171 08/01/2016 08/01/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X I RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Project:Decatur Fire Department Renovation Work-Job No.500832700 City of Decatur and Dewberry Architects,Inc.are included as additional insureds with regards to the General Liability policy as required by written contract. Umbrella Liability policy follows form.Waiver of Subrogation is included on behalf of the additional insureds with regards to the General Liability policy as required by written contract.Umbrella Liability policy follows form. CERTIFICATE HOLDER CANCELLATION City of Decatur SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 Ga K Anderson Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gary ACCORDANCE WITH THE POLICY PROVISIONS. Decatur,IL 62523 AUTHORIZED REPRESENTATIVE 9t or The ACORD name and logo are registered marks of ACORD @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103)