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ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (M08124/201 B12M YY) 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(les) 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 endorsement(s). PRODUCER Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 PO Box 11177 South Bend IN 46601-0177 NAME:GON ACT Ellie Lloyd AICONNo Ext : (800) 814-2122 RIC, No): (800) 836-2122 E-MAIL s: elloyd@gibsonins.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA: Amerisure Mut Ins Co 23398 INSURED HRP Construction Inc. 5777 Cleveland Rd PO BOX 266 South Bend IN 46624-0266 INSURER B: INSURER C : INSURER 0: INSURER E : INSURER F : rnIIroer`ce r1=0T1FIr`AT9: NL 1RAF% P' 9-1-18119 LIaOIIitV 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 TYPE OF INSURANCE INSD WVO POLICY NUMBER POLICY EFF MMIODIYYYY POLICY EXP MMIODIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR XCU CPP20316441302 09/01/2018 09/01/2019 EACH OCCURRENCE $ 1,000,000 G p PREMISES Ea occurrence $ 1,O0o,000 X MED EXP (Anyone person) $ 10,000 X Contractual Liability PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGRECATE LIMITAPPLIES PER: POLICY PEC ❑ LpC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOPAGC $ 2,000;000 $ AOWNED AUTOMOBILE LLABILRY ANYAUTO SCHEDULED ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY IX CA20316461302 09/0112018 09/01/2019 COMBINED SINGLE LIMIT Ea accident s 1,000,000 BODILY INJURY(Per person) s BODILY INJURY (Per accident) $AUTOS PROPERTY DAMAGE Per accident $ $ A X UMBAELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU20316431202 09/01/2018 09/01/2019 EACH OCCURRENCE $ 10,000;000 AGGREGATE $ 10,000,000 nEo I X1 RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE f-N] OFFtCERIMEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA WC203164212 0910112018 09/01/2019 X STATUTE ERPERH E.L. EACH ACCIDENT 1,000,000 $ E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF: OPERATIONS r LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Certificate holder is additional insured with respect to general liability coverages regarding work performed by the insured, r`AAif`CI I ATLnm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 227 West Jefferson AUTHORIZED REPRESENTATIVE South Bend IN 46601 A U 19tit$-1U1S AL:UKLt t;UKF'UKAI IUN. AIL rlgnLs reservea. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD