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Client#: 21954 HARRLLC2
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />1 /09/2020
<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 />�.._ ........... y(° ) __..
<br />RED, the
<br />ust be endorsed. If
<br />ON IS WAIVED,
<br />to
<br />the terms ld I e oof the f such and
<br />and nseoliicy certain policies may W-06Rfkt4_T_ -if thie certificate holder is an ADDITIONAL trequiire an endorsement. A statement on this certificate I does of t confer rights to the
<br />cerPRODU
<br />CO
<br />AgrACT
<br />Lance ER .PHE E E_ 1863 6 6a2113 _ f! c
<br />1115 US w 981South E- ��i ss.;. Renee.Payne@LanierUpshaw.com
<br />fi.N�l
<br />y 863 682 6292
<br />Lakeland, FL 33802 .. .-...... 26883
<br />INSURER S AFFORDING COVERAGE NAIC #
<br />INSUREfR A AIG Speciality Insurance Co,
<br />INSURED
<br />Harrell's LLC, Harrell's, Inc.
<br />P.O. Box 807
<br />Lakeland, FL 33802
<br />Nat'l Union Fire Ins Co................
<br />'.... ... .. ....
<br />INSURER B : f Pittsburgh 19445
<br />------
<br />INSURER C . Markel American insurance Co 28932
<br />INSURER D ; A.I. Surplus Insurance Company 26620
<br />�...
<br />INSURER E :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS
<br />IS TO CERTIFY THAT THE POLICIES
<br />OF
<br />INSURANCE
<br />LISTED BELOW HAVE BEEN
<br />ISSUED TO THE INSURED
<br />NAMED ABOVE FOR THE
<br />POLICY PERIOD
<br />INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION OF ANY
<br />CONTRACTOR OTHER DOCUMENT
<br />WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE
<br />MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFFORDED BY THE
<br />POLICIES DESCRIBED
<br />HEREIN IS SUBJECT TO
<br />ALL THE TERMS,
<br />EXCLUSIONS
<br />AND CONDITIONS OF SUCH
<br />POLICIES,
<br />LIMITS SHOWN MAY HAVE BEEN
<br />REDUCED BY PAID CLAIMS.
<br />NI SR
<br />.....�.,.
<br />TYPE OF INSURANCE
<br />,.,..� .,,,,,"I .........�.
<br />ADDR.
<br />�N'�P3
<br />'Si«!'8F(Im
<br />iI1l k.
<br />POLICY N,,,, MBER
<br />U
<br />POLICY EFF POL�I�CY EXP
<br />MM/DDIYYYY
<br />MM/DD/XYYX,i 5,,,,,,,,,,,,,,,,,,,,�......... 1
<br />.........
<br />LIMITS
<br />.........., ..- ....
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />X M
<br />.....,
<br />EG17937835
<br />3/01/2019 03/01/202
<br />. ._:..... ...
<br />-m. ......
<br />$1,t000 000
<br />CLAIMS -MADE X OCCUR
<br />�
<br />DAMAGETORRENCE
<br />RENTED
<br />PREMISES (Ea nrrurrPnce�l
<br />$300,000 - .
<br />',..-_— ________„ ...,................. ,.
<br />MED EXP (Any one person)
<br />�.. ..- _ _..--_-....,-.,,
<br />$25 000
<br />. ,.+ ------.-.,... .,
<br />PE_RSONAL &,ADV INJURY
<br />$1,0007000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRO-
<br />_ POLICY „ JECT LOC
<br />..........
<br />PRODUCTS -COMP/OP AGG
<br />_.. ..,...
<br />$ 2,000,000
<br />..........
<br />OTHER .................
<br />$$50 000
<br />B
<br />----- ......:..._--
<br />AUTOMOBILE LIABILITY
<br />.....
<br />_.
<br />_.......�................
<br />CA4489811
<br />m ....,... ..............w�
<br />3/01/2019 03/01/202
<br />_Deductible __
<br />COMBINED SINGLE LIMI _
<br />Ea acrldent
<br />......., ...........
<br />1 000,000
<br />X ANY AUTO
<br />''.. All States
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ALL OWNED SCHEDULED
<br />_. AUTOS ......_ AUTOS
<br />.
<br />CA4489812
<br />3/01/2019 03/011202
<br />BODILY (Per
<br />Bo J _.....en
<br />( )
<br />...
<br />$
<br />NON -OWNED
<br />X�,HIRED AUTOS X
<br />MA Only
<br />%E Y1'ASydAG-._.--.
<br />p'ROPERTT
<br />$
<br />AUTOS
<br />�W/alx9dt,_ ��n
<br />PIP
<br />$$10r000
<br />A
<br />m...
<br />UMBRELLALIAB �( OCCUR
<br />I...
<br />EGU17915146
<br />_.. .....
<br />3/01/2019 03/01/202
<br />........
<br />EACH OCCURRENCE m
<br />$15 ,00Q,000
<br />X EXCESS LIAB CLAIMS MADE
<br />_,m...
<br />AGGREGATE
<br />$15 000 000
<br />a
<br />DED X RETENTION $.O.
<br />a
<br />.:.. ..
<br />B
<br />_..,
<br />N
<br />WORKERS COMPENSATION
<br />COMPENSATION
<br />-
<br />...:..
<br />............... ................
<br />WCO25893850
<br />..... ..
<br />3/01 /2019 03/01 /202
<br />........ ...,.
<br />X "sa,TIJTE,. �"
<br />$ ....
<br />AND EMPLOYERS' A
<br />Y Y / N
<br />..
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEI
<br />EXCLUDED? N
<br />"/A.....
<br />All States
<br />E.L. EACH ACCIDENT ...,...�..
<br />$1 00O 000
<br />f....... .t .... ...............
<br />B
<br />NHdeMEMBER
<br />WCO25893851
<br />3/01/2019...03/01/202
<br />E,,!7 ISEASE-,EAEMPLDYEE
<br />$1 OOOt000
<br />FMandaOFFICEtoryinescribe
<br />DESCRIPTION OF OPERATIONS pain OPERATIONS
<br />''..
<br />- .......
<br />E L DISEASE -POLICY LIMIT
<br />........a .. ..............
<br />$1,000,000
<br />A
<br />Pollution Liabili
<br />EG17937835
<br />3/01/2019 03/01/202
<br />$2,000,000/$50,000
<br />Died
<br />C
<br />'Rented/Leased Eqp
<br />MKLM31MOO501
<br />3/01/2019 03/01/202
<br />$500,000 Per Item/Occur
<br />D
<br />Prof Liability
<br />EMP1900056101
<br />3/01/2019 03/011202
<br />$1,000,000/$10,000
<br />Ded
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />RE Bid Name: Venues Parks & Arts 2020 Chemical Supply
<br />Certificate holder, City of South Bend, their affiliates and or assigns are included as additional
<br />insured in respects to general liability on a primary and noncontributory basis and auto liability as
<br />required by written contract. Waiver of subrogation applies to additional insured(s) for general liability,
<br />auto liability and workers compensation. Umbrella follows form of general liability, auto liability and
<br />workers compensation.
<br />TION
<br />City of South Bend Office of the SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W. Jefferson Blvd, Ste 1316
<br />South Bend, IN 46601 AUTHORIZED REPRESENTATIVE
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S470303/M466402 SRP
<br />
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