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

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DATE(MM/DD/YYY`!) A�" CERTIFICATE OF LIABILITY INSURANCE 1112812016 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(les)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). CONTACT PRODUCER E: NAMME: Brooke Kuemmerle CCMSI PHONE FAX (800)-252-5059 1174 ac No c%Cannon Cochran Management Services,Inc. E-MAIL Towne Centre Building ADDRESS: bkuemmerle@ccrosi.com 2 East Main Street INSURERS AFFORDING COVERAGE NAIC# Danville,IL 61832 INSURER A:CONSOLIDATED CONSTRUCTION SAFETY FUND OF ILLINOIS INSURED INSURER B: FELMLEY-DICKERSON CO. 401 E LAFAYETTE INSURER C BLOOMINGTON,IL 61702-1550 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 SUBR POLICY NUMBER MM/D Y EFF MM/DDY EXP LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE FIOCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F7JECTPRO F_� LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY L I 1 1 $ AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 2,000 000 A OFFICER/MEMBER EXCLUDED? � N/A X WC00200020015 12/31/2015 12/31/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) PROJECT: DECATUR FIRE DEPARTMENT RENOVATION WORK/WAIVER OF SUBROGATION PER WRITTEN CONTRACT/ADDITIONAL INSUREDS DOES NOT APPLY TO WORKERS COMPENSATION/30 DAYS WRITTEN CANCELLATION NOTICE SAFETY NATIONAL PROVIDES EXCESS WIC INSURANCE/N EXCESS OF PROGRAM RETENTIONS CERTIFICATE HOLDER CANCELLATION CITY OF DECATUR 1 GARY K ANDERSON PLAZA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DECATUR,IL 62523 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .j�ti,Q,tII(Yft,flllQ, @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CertReCID:180385 PRID:311915069