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�acoRo� CERTIFICATE CIF LIABILITY INSURANCE <br />DATEIMId9/16/2016I016Y) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pol€cy(les) must be endorsed, If SUBROGATION IS WAIVED, subject 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 />certificate holder In ffeu of such andorsement(s). <br />PRODUCER <br />Gibson Insurance Agency, Inc. <br />NAME: T Stacy Christlieb <br />PHONE (BOO) B14-2122 C Na; (0001836-2122 <br />130 S Main St, Ste 400 <br />ooAEs,schristlieb@gibsonins.com <br />INSURER 5 AFFORDING COVERAGE <br />NAIC If <br />PO Box 11177 <br />South Bend IN 46601--0177 <br />INSURER AAZ6riSuke Ins CO <br />194BB <br />INSURED <br />INSURER B.Travelers Prop Cas Co of Amer <br />25674 <br />INSURERC: <br />Selge Construction Co Inc <br />2833 S 11th St <br />INSURERD: <br />IN90RERE: <br />INSURER F : <br />Niles MI 49120-4421 <br />COVERAGES CERTIFICATEA€tIMRFR-08-31-16/17 Liability RFVIRIOMM11KARFR• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES 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 />IIN.iR <br />TYPkOFINSORANCE <br />O G UMBER <br />POLIOYEFF <br />P P <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACHOCCORRENCE <br />S 1,000, 000 <br />DAMAOE TO RENTED <br />PREMISES EaoccUrcance <br />S 300,000 <br />A <br />CLAIMS -MADE a OCCUR <br />X <br />MEDEXP(Anyone, poison j <br />S 1D,000 <br />XCU <br />CPPRO902400101 <br />8/3112016 <br />0/31/2017 <br />Contractual LiabilityPERSONAL&ADVINJURY <br />$ 1.,000,000 <br />X <br />UMITAPPLIES PER: <br />GENERAL AGGREGATE <br />3 2,OOD, 000 <br />GEN'LAGGREGATE <br />POLICY N JEC n LOG <br />PRODUCTS - COMPIUPAGG <br />$ 2,OOD,000 <br />_ <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED 810Lt aMIT <br />(En accldenl <br />$ 1,000,000 <br />80tHLY INJURY (Per person) <br />$ <br />A <br />X ANY AUTO <br />BODILYINJURY(Peraccident) <br />S <br />ALL AUTOS AUTOSULED <br />CA20982410101 <br />0/31/2016 <br />8/31/2017 <br />NON -OWNED <br />X HIRED AUTOS fX AUTOS <br />PROPER? DAMAGE <br />Per accident <br />S <br />_ <br />S <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 10 000 OOO <br />AGGREGATE <br />S l0 000 000 <br />A <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED I X I RETENTIONS 0 <br />g <br />ICO20982430101 <br />8/31/2016 <br />8/31/2017 1 <br />WORKERS CCMPENSATIO14 <br />X TA7lJTE OT <br />YIN <br />AND EMPLOYE"' LIABILITYANY <br />E.LEACHACaoENT <br />_ <br />S v 500 Q0U <br />PROPRIETOMPARfNERrtXECUTNE <br />NIA <br />EL OfSEASE - EA FMPLOYSI <br />S 500 000 <br />A <br />OFFtCEMMEMBER EXCLUOED7 <br />(Mandatory In NH) <br />WC20982a401 <br />0/31/203.6 <br />8/3L/2017 <br />If yyes d"enbeunder <br />DESCRIPTION OF OPERATIONS baTw, <br />E.L DISEASE - POLICY LIMIT <br />$ 500 000 <br />* <br />Excena Umbrella <br />ZUP1180085016 <br />8/31/2016 <br />6/31/2017 <br />Each Occurrence $131000,000 <br />Aggregate $13, 000 , D00 <br />DESCRIPTION OF OPERATIONS t LOCATIONS 1 VENCLES (ACORD 101, Additional Remarks Schock le, may be attached If more apace Is regUlredE <br />Certificate holder, Chicago South Shore and South Bend are additional insured with respect to general <br />liability and auto liability coverages regarding work performed by the insured. <br />Norfolk Southern Railway Company <br />Three Commercial Place <br />Norfolk, VA 23510 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLFDBEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Ins Agency/ELLIE Jew <br />©1988.2014 ACORD CORPORATION. All rinhts resarvarl_ <br />ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD <br />INS025 imunll <br />