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Client#: 26256
<br />DL,ZCORPO
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (M,MIDDNYYY)
<br />1 312212018
<br />THIS CERTIFICATE IS ISSUED AS 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(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />............ _.. . ....... ....... .... . . . . .........
<br />IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION IS WAIVED, subject: to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer any rights to the certificate holder In lieu of such endorsoment(s).
<br />PRODUCER COAT
<br />NA E.CT Katie Kresner
<br />Greyling Ins. Brokerage/EPIC PHONE 770.552,422.5FAx
<br />(AIC No, Ext): N.): $66.550.4082
<br />3780 Mansell Road, Suite 370 E-MAIL
<br />ADDRESS, Katle.Kresnor@groyling.com
<br />Alpharetta, GA 30022 ....................
<br />INSURED
<br />DLZ Indiana LLC
<br />2211 East Jefferson Blvd.
<br />South Bond, IN 46616
<br />I INSURER A: N.U.ral Uri -Firm In, Ca PA Ttt�__ I
<br />I!NSURER 1: OBE Insurn— Coipamtlan 39217
<br />-INSURERC LI.Yda0fl-0od..
<br />COVERAGES CERTIFICATE NUMBER::, 18-19 REVISION NUMBER:
<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 />i_WdR ADDLSUBR POLICY EXP
<br />LTR TYPE OF INSURANCE INSR WVD 1,1 IC MMIDRPr LIMITS
<br />_. __ (005 L —jon
<br />• X COMMERCIALOENERAL LIABILITY GL5268221 04101/2018 041ID11/2019
<br />--71EACHOCCURRENNCE $1,000,000
<br />CLAIMS -MADE OCCUR �.ETE,1ce) $500000
<br />MED EXP (Any one person) $25.000
<br />PERSONAL & ADV INJURY $1,000,000
<br />GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,0010,000
<br />E"
<br />F_V� PRO -
<br />POLICY 1 -1 JECT 171 LOC �RD.YCTR _G.MP'OP AG. $2,000,000
<br />OTHER: $
<br />• AUTOMOBILE LIABILITY CA"89714 0410112018 04/0112019 COMBINED SINGLE. LIMIT 1110001000
<br />A ANY AUTO BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
<br />X HIRED NON -OWNED PROPERTY DAMAGE
<br />AUTOS ONLY AUTOS ONLY Per accident)— $
<br />B X UMBRELLA LAB X OCCUR CCU3977348 0410112018 04/0112019 EACH OCCURRENCE $15,000,000
<br />EXCESS LIAS CLAIMS -MADE AGGREGATE $15,000,000
<br />-..T-x7 RETENTION $10,000
<br />0410112018 041011 1801T, H-
<br />A WORKERS COMPENSATION 2019 7EA&TE
<br />AND EMPLOYERS' LIABILITY YIN WC015893,7'83
<br />ANY PROPRIETOR/PARTNEPJEXECUTIVE[.--] E.L. EACH ACCIDENT $1,000, Doo
<br />OFFICERIMEMBER UXCUJ N N/A
<br />(Mandatory In NH) EMPLOYEE $1,000,000
<br />Ugs, describe under E.L.fLDISEASE - E
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
<br />C Professional Llab B0146LDUS,A1804157 01/0112018 04101/2011 Per Claim $5,000,000
<br />Incl Pollution Aggregate $6,000,000
<br />Liability
<br />DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Re: Colfax Avenue Two -Way Conversion - City Project 115-053; Indiana. City of South Bend is named as an
<br />Additional Insured with respects to General & Automobile Liability where required by written contract.
<br />Should any of the above described policies be cancelled by the issuing insurer before the expiration date
<br />thereof, we will endeavor to provide 30 days" written notice (except 'l 0 days for nonpayment of prem!"r
<br />the Certificate Holder.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />227 W. Jefferson Blvd. ACCORDANCE WITH THE POLICY PROVISIONS.
<br />South Bend, IN 46615-0000
<br />AUTHORIZED REPRESENTATIVE
<br />1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) 1 of The ACORD name and logo are registered marks of ACORD
<br />010090171IM11004019 KKRE1
<br />
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