Opening of Bids - 2017 Trucking of Belt Pressed Biosolids for Land Application - Trucks R Us

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OP ID: CH ,A11*. a CERTIFICATE OF LIABILITY INSURANCE DATE 11012017 02110/2017 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 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 endorsements . PRODUCER R.S. Miller & Sons, Inc. P.O. BOX 229 109 W. Plymouth Street Bremen, IN 46506 Gregory S. Miller, CPCU,CIC CONTACT Gregory S Miller, CPCU, CIC NAME: PHONE 574-546-3341 ac Ne :574-546-2687 A/c No at,: EMAIL ADDRESS:PRODUCER CUSTOMS to a: TRUCK-1 INSURERS AFFORDING COVERAGE NAIC N INSURED Trucks R Us, Inc. INSURER A: West Bend Mutual insurance 15350 _ Lake Effect Excavating, Inc Lake Effect Snow Removal INSURER B: Lake Effect Auto Sales INSURER C 23943 State Road 2 INSURER D: South Bend, IN 46619 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 LTR OF INSURANCE ADDLITYPE INgR BUB POLICY NUMBER MMIDO/YYEYYV MM/DD/VYVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY A040137 0710512016 07105/2017 PREMISES Eaoccurence $ 200,000 MED EXP (Any one person) $ 5,00 CLAIMS -MADE a OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 BERL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 $ -- POLICY X PRO LOG A AUTOMOBILE LIABILITY ANY AUTO A040137 0710612016 0710512017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALLOWNEDAUTOS PROPERTY DAMAGE (PER ACCIDENT) $ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS $ A UMBRELLA LIAR EXCESS LIAB I X OCCUR CLAIMS -MADE A040137 0710512016 0710512017 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,000 DEDUCTIBLE $ TH X WOR LIMITS ER - $ A A X I RETENTION S 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, RdeIPsTIcribONe untlerOFOPERATIONS below DESC Motor Truck Cargo I A040149 040137 0710512016 0710512016 0710512017 0710512017 E.L. EACH ACCIDENT $ 500,000 E. L. DISEASE -EA EMPLOYEE $ 500,000 E. L. DISEASE - POLICY LIMIT $ 500,00 MTCargo 100,000 ded 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 401, Additional Remarks Schedule, if more space Is required) City Of South Bend 125 S. Lafayette Blvd. Suite 100 South Bend, IN 46601 ACORD 26 (2009109) CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gregory S. Miller, CPCU,CII ©1988J4609 ACOR The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved.