|
CERTIFICATE OF LIABILITY INSURANCE
<br />OATS (MMMUfYYYY)
<br />17100I20i7
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIt3HTS UPON THE CERTIFICATE HOLDER. THIS
<br />CEIkTIPICATL DOES HOT AFFIRMATIVELY Ol7 NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CRRTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED, the policy(Ies) must have ADDITIONAL INSURED proVta ons or be endorsed,
<br />If SU13ROOATION IS WAIVED, subject to the term® and conditions of the polloy, certain polleles may requlM . an endoesootent, A eiatomont on
<br />this certificate does not confer rights to the cortlfloate In In lion of such endorsoment(s),
<br />PRODUCER
<br />Shophordlnaurance,LLC.
<br />111 Congressional Boulevard
<br />Suite 100
<br />Catmol IN 46032
<br />t Paige Sexton
<br />(317)848.6554 o yet (317)616-6444
<br />1L&,—cerI;sQ9hephord!ns.com
<br />IN9UaHRtS)A0OR0IN000VERA09
<br />NATO p
<br />INSURUkA t AMOO Ins Co
<br />10100
<br />INSURED
<br />Patson 1no,, DOA, TransChlcago Truck Group
<br />000 N York Poad
<br />Elmhurst IL 60128
<br />IN6URERB I
<br />INOUPOR 0 t
<br />INSURER O t
<br />INSURER E 7
<br />NSUnERP:
<br />rn,.Anrics ^u171'MhftAT0 Ait laaO60. L:L11LKJut31UfJb RF_VISILIIV IIJUMMLa FIC
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANcE Lt8TE0 BELOW HAVE B[EN is$UEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED,, NOTWETHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMfiNT WTH RESPECT TO WHICH THIS
<br />060117I0ATe MAY 61= ISSUED OR MAY PERTAIN, THE IN$URANGE'AFFORDED BYTHE POLICIES VKSCRIBEQ HEREIN IS SUBJECT TOALL THE TERMS,
<br />EXCLUSION$ AND CONDITIONS OP SUCH POLICIES. LIMITS SHOWN NtAY HAVE BEEN 0DUCE15 BY PAID CLAIMS.
<br />It T
<br />TYPE OF INSURANCE
<br />M D
<br />IMA
<br />0
<br />LIMIT$
<br />}(
<br />OOMMERDIALOENERALLIABILITY
<br />VACHOCCURRENCE
<br />5 1,040,000
<br />PREMISES Eeo rta '
<br />$'100,000
<br />CLg1M5,MAOE (`_-, ccouk
<br />MED Exp An ono ' oroarif
<br />6' 5,000
<br />A
<br />ACPGPA31008400406
<br />0010112017
<br />0916V2018
<br />p RSONAL6ADVINJURY
<br />s 1,A04.000
<br />OEULAGGREOATELfA11iAPPUESPER:
<br />POLICY Loa
<br />OTHER
<br />OENERALALIORERATE
<br />$ 30000,000
<br />PRODUOTS•100 PIOPAOO
<br />3,000,000
<br />AUTOMOBILE LIABILITY
<br />IM
<br />E 4en1
<br />$ 11600,000
<br />BODILY INJURY(Parpaleon)
<br />$
<br />X ANY AUTO
<br />Sov3LYINJURY (eoraceldent)
<br />S
<br />A
<br />OWNED SCHEDULED
<br />AUTOSONLY AUTOS
<br />HIRED NON-OWNEDParaE
<br />AUTOS ONLY AUTOS ONLY
<br />K Garage Mob
<br />ACPOPA30084D0408
<br />0910112017
<br />OD101l20i0
<br />�
<br />$
<br />Lhnit
<br />s 1,000,000
<br />A
<br />�(
<br />UMRRELLALIAD
<br />r;XOESSLIAE
<br />P(
<br />OCCUR
<br />cLAINS-MADE
<br />ACPOAA3006409406
<br />00/01/2017
<br />OOM1120i8
<br />EAC4000URRENCE
<br />!: 10,000,000
<br />ARtfAtOATE
<br />g i0,000,400
<br />DED iC RETENTION $ 0
<br />WORKERSCOMPRNSATION
<br />AND EMPI.OYRRV LIAUILITY
<br />ANYPROPAIETORIPARTNURIExecuylVN Yj'""MJ
<br />O>`FICERlMEMBER�LCLUDED4 ��
<br />(h%ridatotyInNR
<br />fIYea,doaodbaonor
<br />DESCRIPTION OF OPERATIONS heluN
<br />N1A
<br />p
<br />STATUTE E
<br />E.L:EACMACCID[INT
<br />V,L,OISIIASE-VAEMPLO eA
<br />S
<br />E.L:DI5iASE-POMOYLII,4IT
<br />6
<br />GomplC011 bed: 2,600
<br />Blkl 8,600,000
<br />APhysical
<br />Damage'(Invento€y)
<br />tier@gokaopers
<br />ACPGPA300840040.8
<br />09lo112017
<br />0olo112018
<br />Complooll Dod: 5,000
<br />B)k: 8,400,000
<br />DESORIPTION OF OPERATIONS I LOCATIONS I V9HICLES (ACORD 101, Additional Rdntuka Saltadule, maybe altaahod Ef mora srinoo le roqul(od)
<br />Re: Bid Bond
<br />For: SpeoAD Tandom Axle UUmp TrUck wIA11 Requitod Equipment
<br />Amount: 10%.olContract Alnountof$185,OR0.00 '
<br />401W cr South Bend Pubilo Works
<br />13(h Floor, County-CAy Bldg
<br />Room 1316, 227 W. J600804
<br />South Band
<br />IN 46601
<br />SfIOULO ANY OF THE ABOVE DESCRII]IRD POLICIES K CANCELLED 09FORE
<br />TH[s GXPiRATION DATE THEREOF, NOTICE WIL4 BE 09MVERR0 IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED
<br />0 4099.2018 ACORD CORPORATION. All rlahts reserved.
<br />ACORD 26 (2016103) TITS ACORD natrte and logo are r 018tered Marks of ACORD
<br />
|