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DATE (MWODNYYY)
<br />11 /16/201 B
<br />1%.�-. CGFRTIFICATE OF LIABILITY INSURANCE E ACCt 24,94064
<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 BELOW.
<br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER NAM6dCT
<br />Lockton Companies, LLC - FAx
<br />PHONE
<br />2100 Ross Ave., Suite 1400 AJC Ne Eap 214.71 +td1( 111 (A/c No)
<br />Dallas, TX 75201 E. REss we@resourcm.- d com
<br />INSURER A : Indemnity Insurance Co. of North America
<br />INSURED
<br />INSURER B
<br />Resourcing Edge I, LLC
<br />INSURER C
<br />1309 Ridge Rd., Suite 200
<br />Rockwall, TX 75067
<br />wsuaEa„o , ---------
<br />'SEE BELOW
<br />INSURER E :
<br />COVERAGES CERTIFICATE NUMBER: AFVlglnN NIIURr-R-
<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 />INSR.,. TYPE OF INSURANCE _._.-._... ADD SUER ,.., ,.POLICY EFF 0160CY tXP .... ,....
<br />LTR INSD WVD POLICY NUMBER (MMIDD/VYYY) (MM/DDIYYYY) LIMBS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$
<br />..
<br />DAMA�iE TO RENTED ....
<br />..
<br />CLAIMS- OCCUR
<br />[
<br />PREMISESLEactucurrenael.
<br />,„$....
<br />MED EXP (Any one persona
<br />$
<br />......
<br />PERSQ L,&ADVINJURY
<br />GENL AGG TfL LIMPE.PEY,R:
<br />�
<br />PIP�1Of
<br />r.T 4PGLICY
<br />...
<br />PRODUCTS COMP/OP AGG
<br />$
<br />THEW
<br />$
<br />AUTOMOBILE LIABILITY
<br />,
<br />COMBINED SINGLE DUN—
<br />$
<br />..,,...
<br />t w
<br />f.Ea accident) .,, ..........
<br />- ,..,.,.. .........
<br />ANY AUTO
<br />....., -- --
<br />�
<br />BODILY INJURY (Per person)
<br />..................
<br />$
<br />-------- ....
<br />WNED SCHEDULED
<br />,,.,,..,... AOUTOS ONLY ,% AUTOS
<br />'^m
<br />BODILY INJURY (Per accident
<br />(
<br />$
<br />HIRED NON -OWNED
<br />.... .........)
<br />I�ROPERTYDAMAGE
<br />$ ��� ----
<br />.,........,. AUTOS ONLY ........_ AUTOS ONLY
<br />µ,
<br />..(Per accidenU ... ............. .........
<br />----- .,... „
<br />UMBRELLA LAB OCCUR
<br />,mm
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LIAB CLAiMS44ADE
<br />...
<br />,N;3
<br />.......... ---
<br />AGGREGATE
<br />....
<br />_................. ... .......---------
<br />....... ._-.
<br />DED � R "T .. TI N'
<br />$
<br />'WORKERS COMPENSATION
<br />�/ P R.... OTH
<br />AND EMPLOYERS LIARII_ITV Y
<br />X 6TaT.UTZ ,.....
<br />A
<br />ANYPROPRIETOR/PARTNERIEXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />C65660799
<br />�01a20118
<br />10/01/2019 E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />.
<br />I1 yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E L DISEASE EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />I
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more sp a Is required)
<br />Green Demolition Contractors Inc. (2496) is included as a named Insured through endorsement.
<br />A overage provided for all leased employees but not subcontractors of: Green Demolition Contractors Inc.
<br />E: JOB: PREOUAL
<br />GREEN DEMOLITION CONTRACTORS INCORPORATED, LLC
<br />'b23 NORTHBROOK DRIVE
<br />MICHIGAN CITY, IN 46360
<br />rrcnlirwriir- nvLUCn GANGtLLAIIUN
<br />2494064
<br />CITY OF SOUTH BEND INDIANA DEPT. OF PUBLIC WORKS
<br />227 WEST JEFFERSON
<br />MICHIGAN CITY, IN 46360
<br />ACORD 25 (2016/03)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
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<br />©1
<br />The ACORD name and logo are registered marks of ACORD
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