Opening of Bids - Water Works Utility Service Line Repair Program - Bob Frame

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iYk GATE IMM(DDNYYY) OORV CERTIFICATE OF LIABILITY INSURANCE 11/01I2019 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 PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: RID BOX 328 OWATONNA, MN 55060 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 264-429_2 INSURER e: FEDERATED SERVICE INSURANCE COMPANY 28304 BOB FRAME PLUMBING SERVICES INC INSURER . ................................ .................. ............... :......................... � ,m _ -.. 2442 JACLYN CT...............................................................................................:.: .....:.. ..m.__ .. ._ SOUTH BEND, IN 46614-3700 INSURER D`....................................._.................. .............................. ....,- , n.----.,-„_.................. _, -_. -- INSURER E: INSURER F: COVFRAOES CERTIFICATE NUMBER: 22 REVISION NUMBER: 4 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,. IH.R ADDL &Y,Y$'dY� POLICY E'FF POLICY EXP g TYPE OF INSURANCE Ily, R POLICY NUMBER MMIDDI VYYf(MmlowxyYYJ. LIMITS X '.. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR ❑X DAMAGE TO RENTED „%,N,'lll„�f,�-P,Swn&Sf., $100000 --� MED ExP (Any one person) EXCLUDED B Y N 9403507 04/01/2019 04/01/2020 PERSONALS ADVINJURY INJURY ,.... D000 $1 000 C m -- iY'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 0 O00 X A'noi FI $2 000,000 POLICY ACT LOC PRODUCTS - COMP IOP AGO OTHER: AI.11'O:tlikY.CULL LIABILITY COMBINED SINGLE LIMIT $1.000 000 _ 1La ?&W!"n.4 X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED B Au7os - N N 9403507 04/01/2019 04/01/2020 BODILY INJURY (Per accident) NON -OWNED HIRED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE lkff WWAd&PILm__-._._ .. Yo I.IfAUHVr<i.Y A &1'.AU X OCCUR EACH OCCURRENCE $2,000,000 B EXCESS LIAB CLAIMS -MADE N N 9403508 04/01/2019 04/01/2020 ACCREC ATE $2,000,000 DED RETENTION WORKERS COMPENSATION STATUTE I Y�IjNRA ANY PROPRIETOR XECUTIVE X�ER . EACH ACCI $500,000 A OFFICER/MEMBER EXCLUDED? N 9403509 04/01/2019 04/01/2020 (Mandatory In NH) EDISEASE EA EMPLOYEE _ $500000 '..__.._..... ........ If yes. demcAhe under •••PO m........_ E L DISE••,.,ASE POLILICY LIMIT $500 500,000 I DESCRIPYLON OF OPERATIONS beIaW DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. CERT'WICAT'E HOLDER CANCELLATION 264-429.2 22 4 CITY OF SOUTH BEND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 227 W JEFFERSON BLVD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTH BEND, IN 46601-1830 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016tO3) The ACORD name and logo are registered marks of ACORD