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CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)
<br />12/11 /2018
<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
<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 />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 tights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT Julia Hoskins
<br />NAME;
<br />Pillar Group Risk Management PHONE (317) 853-3568 . ��FA�(317� g53.....
<br />-3589
<br />a Div of Dimond Bros Insurance ?n ANu. Ext)_ q,1r( No). )
<br />_..._ .__
<br />ADDRESSu lhoskins@pillargroup..com
<br />11708 N. College Ave.
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />Carmel IN 46032 INSURER, Amerisure Mutual Insurance Co 23396
<br />INSURED INSURER a: Amerisure Insurance Company 19488
<br />Performance Services, Inc. INSURER C : Travelers Property Casualty Co ofAmerlca 25674
<br />4670 Haven Point Blvd #200 INSURER D : Federal Insurance Company 20281
<br />INSURER E :
<br />Indianapolis IN 46280 INSURERF:
<br />COVERAGES CERTIFICATE NUMBER: 18-19 MasterALLCOV 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 CONTRACTOR 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 />TYPE OF INSURANCE .... - DTI°cv EFF POLICY _..EXP a ....... ..
<br />,,,,,,,POLICYNUMBER
<br />R BF N (MMIDDIYYYY MM/DD/YYYY LIMITS
<br />_, INSD WVD
<br />1:7
<br />MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />v T__
<br />CLAIMS -MADE � OCCUR PREMISES &80Courrance�$ 1,000,000
<br />B
<br />GEN1AGGREG�ATELIMITAPPLIES PER:
<br />POLICY [g PRO E LOC
<br />,tlEGT
<br />OTIiER�
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO
<br />B OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A/C � EXCESS ABUMBRELLA IAB � OCCUR
<br />DEC RFMNTnON $ 0
<br />__....__
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />B OFFICER/MEMBER EXCLUDED? N N/A
<br />(Mandatory in NH)
<br />If ves. describe under
<br />DESCRIPTION OF OPERATIONS below
<br />D ILeased/Rented Equipment
<br />Transit
<br />MED EXP (Any one person)
<br />$ 10,000
<br />CPP1323442
<br />12I06/2018
<br />12/06/2019
<br />PERSONAL BADVINJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000 000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000000
<br />coacINED SlrvaGtE' aMIT
<br />dCa accidantti
<br />$ 1 000,000
<br />BODILY INJURY (Per person)
<br />$
<br />CA1381318
<br />12/06/2018
<br />12/06/2019
<br />I BODILY INJURY (Per accident)
<br />$
<br />P I R "ERT'N" &7AMAGE
<br />$
<br />Per occid0L4)
<br />EACH OCCURRENCE
<br />$ 10,66Q000
<br />CU2033750/ZUP14NO733418NF
<br />12/06/2018
<br />12/06/2019
<br />AGGREGATE
<br />$ 10,000,000
<br />Excess Umbrella
<br />$ 10 000,000
<br />X PER -1
<br />STATUTE ERiH-
<br />WC1328253
<br />12/06/2018
<br />12/06/2019
<br />EL. EACH ACC-IDENT
<br />$ 1,000,000-•..-..• ..
<br />E,L. DISEASE.._. - EA EMPLOYEE
<br />- ..__._._...
<br />$ 1,000,000
<br />E. L. DISEASE -POLICY LIMIT
<br />....... _............ _
<br />$ 1,000-000
<br />$125,00' per Item/Occ
<br />$5,000 Ded
<br />45470495
<br />12/06/2018
<br />12/06/2019
<br />$400,000 Claim/Agg
<br />$1,000 Ded
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Ut:K I11^ItUAI It HULDEK CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Performance Services, Inc. ACCORDANCE WITH THE POLICY PROVISIONS.
<br />4670 Haven Point Blvd
<br />Suite 200 AUTHORIZED REPRESENTATIVE
<br />Indianapolis IN 46280 ( w�
<br />©1983-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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