|
DATE (MWDD/VYYY)
<br />11/16/2018
<br />OHM
<br />11
<br />A � ,1 I Pill
<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(ies) 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
<br />Lockton Companies, LLC
<br />2100 Ross Ave., Suite 1400
<br />Dallas, TX 75201
<br />INSURED
<br />Resourcing Edge I, LLC
<br />1309 Ridge Rd., Suite 200
<br />Rockwall, TX 75087
<br />'SEE BELOW
<br />E-MAIL ADDRESS:
<br />INSURER A: Indemnity Insurance Co. of North America
<br />INSURER B :
<br />FAX
<br />(A/C, No):
<br />COVERAGES CERTIFICATE NUMBER: 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 />............. .......-...-,POLIC'V�EFF,..._. P LT�EAf7.F�. �..._..........., .......__.
<br />IINSR' ..,n.m,n............... d4pfiL 3�iY'__ . ... ...,..._m,..,.......... .,....
<br />BR.
<br />TYPE OF INSURANCE
<br />POLICY..
<br />LTR INSD WVD NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />DAMAGE TO �I�ENTED ,,,,. �...
<br />CLAIMS- OCCUR
<br />PRFMISFS !Fa occurrenrei ......,- $
<br />MCD FXP (Aoy wte paiuoip) $_..
<br />PERSONAL &. ADV IN„NURY _..._.$ ___..............
<br />'',4„+I L AGGEa;,lakTN" LIMP"I" I P�"S PEW
<br />Ol PRO I pLOC
<br />L ENEHAI AGGA b __
<br />PRODUCTS COMPIOP AGG $
<br />..
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) $
<br />HIRED NON -OWNED
<br />I
<br />PROPERTY DAMAGE y
<br />., ,._.. AUTOS ONLY ,,.,.V AUTOS
<br />I�I
<br />& Y
<br />6
<br />6P_aa aca:idaDU ... $
<br />$
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE $
<br />........ _..-- -.. .............
<br />EXCESS LIAB CLAIMS -MADE
<br />..
<br />........ ---
<br />AGGREGATE. $
<br />-. _.$ _...
<br />DEB RETENTION
<br />WORKERS COMPENSATION
<br />x PER OTH
<br />AND EMPLOYERS uABlury Y
<br />A
<br />�T�T TF �R
<br />OFFICER/MEMBER EXCLUDED? /l,Ul IVE
<br />NH
<br />N IA
<br />C65880799
<br />10I01/2018
<br />10/01I2019
<br />E.L EACH ACCIDENT
<br />$ 1,000,000
<br />(Mandatory )
<br />........ ............... -- - — — ,,
<br />......
<br />If yes, describe under
<br />'iDESCRIPTION OF OPERATIONS below
<br />DISEASE EA EMPLOYEE
<br />$ 1 t)00 t)00
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 1.01„ Additional ffsmarks' ckodulo, may be attooh#4 Il mio-re space is required)
<br />Green Demolition Contraclors Inc. (2496) Is included as a named Insured lbrou�gh endarsemenl.
<br />Coverage Provided for all leased employees but not subconlreclors of: Green De�rnolilon Contractors Inc.
<br />RE: JOB: PREOUAL
<br />GREEN DEMOLITION CONTRACTORS INCORPORATED, LLC
<br />Va NORTHBROOK DRIVE
<br />ICHIGAN CITY, IN 4636e
<br />CERTIFICATE
<br />2494064
<br />CITY OF SOUTH BEND INDIANA DEPT. OF PUBLIC WORKS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />227 WEST CITY, I 463 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ON
<br />MICHIGAN CITY, IN 46360 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|