Opening of Proposals - Water Works Utility Service Line Repair Program - Niezgodski Plumbing Inc

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A �'� CERTIFICATE OF LIABILITY INSURANCE TE �) 47/11t2018 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 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 endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 'N=ig CT ENT CONTAMCENTER gIONHo Ect : 888-333-4949 FAX No): 507-4464664 AooASS: CLIENTCONTACT ENTER FEDINS.COM OWATONNA, MN 55060 INSURERIS) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 230-909-4 INSURER B: FEDERATED SERVICE INSURANCE COMPANY 28304 INSURERC: NIEZGODSKI PLUMBING INC PO BOX 3096 SOUTH BEND, IN 46619-0096 INSURER P: INSURER E: INSURER F: �[�v�Rnc3t=s CERTIFICATE NUMBER: 137 REVISION NUMBER: 0 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 SEEN REDUCED BY PAID CLAIMS. INS R LTR TYPE OF INSURANCE ADDL g SUBR POLICY NUMBER POLICY EFF 1DD1Y Y POLICY EXP DD LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR BUSINESS OWNER'S LIABILITY N N 9041601 08/21/2017 08/21/2018 EACH OCCURRENCE $1,000,000 PRCMIGStSE T Ea RENTED $100,000 X MED EXP (Any one person) $5,000 GEN't. X PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ LOC OTHER: JECT GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPfOP AflO $2,000,000 B AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOSUEED HIRED AUTOS ONLY NON -OWNED AUTOS ONLYccirigntl N N 9041602 08/21/2017 08/21/2018 COMBINED SINGLE LIMIT E a dent $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accidenj PROPERTY DAMAGE A X UMBRELLA LIp8 EXCESS LIAG X OCCUR CLAIMS -MADE N N 9041603 08/21/2017 08/21/2018 EACH OCCURRENCE $2,000,000 AGGREGATE $2,0()0,()00 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTHERIEXECUTIVE Y A N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) II yes, describe under DESCRIPTION OF OPERATIONS below NfA N 900604 08/21/2017 08/21/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $540,000 E.L DISEASE - POLICY LIMIT $51)( 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) r..FRTIrI('oTF Uni nFR CANCELLATION 230-909-4 CITY OF SOUTH BEND BOARD OF PUBLIC WORKS 227 W JEFFERSON BLVD FL 13 SOUTH BEND, IN 46601-1830 1370 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 W 1bW lUlb AL:VNIJ k:VF[YVKAI IVTI. IYII 1-181II5 ►UNUMCO. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD