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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<br />12/31/2019
<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 riqhts to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />MARSH USA INC.
<br />540 W. MADISON
<br />CHICAGO. IL 60661
<br />Attn: Chicago.CertRequest@marsh.com I Fax: 212-948-0770
<br />INSURED
<br />Superior Construction Co., Inc
<br />1455 Louis Sullivan Drive
<br />Portage, IN 46368
<br />AFFORDING COVERAGE
<br />INSURER A: N/A
<br />INSURER B : N/A
<br />INSURER C : Indian Harbor Insurance
<br />INSURER D :
<br />COVERAGES CERTIFICATE NUMBER: CHI-007275821-14 REVISION NUMBER: 7
<br />N/A
<br />N/A
<br />36940
<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
<br />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� .�ADDL)SiYB6a'.. ..,.,.,.,
<br />POLICY EFFI POLICYYEXP 1
<br />TYPE OF INSURANCE
<br />LTR POLICY NUMBER
<br />pp,ryyXy. MWD nYYY LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />1 EACH OCCURRENCE
<br />$
<br />CLAIMS -MADE IMS-MADE OCCUR
<br />PREM!SES,nas occurrence�j_
<br />$
<br />..
<br />MED EXP (Any one person)....
<br />$ ....... .....
<br />�... .,- ,,,,
<br />PERSONAL 8 ADV INJURY
<br />$
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />I lr
<br />PRO,
<br />POLICY JECI` LOC
<br />" _
<br />PRODUCTS COMPIOPAGG
<br />...
<br />,$
<br />Ol'HER.
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />I $
<br />accident)
<br />....
<br />AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />�
<br />BODILY INJURY (Per accident)
<br />�$
<br />HIRED NON -OWNED
<br />AUTOS ONLY
<br />...
<br />DAMAGE
<br />b ....w ....,,.,,,,
<br />$
<br />a AUTOS ONLY
<br />f.�
<br />(PRC)PERTY
<br />Par acr„�denl)
<br />"yy ,...,,
<br />I UMBRELLA LIAB J OCCUR
<br />EACH OCCURRENCE
<br />EXCESS LIAB ,� CLAIMS -MADE
<br />....DED ,. .-�
<br />AGGREGATE
<br />.. ,.,.,., ......
<br />S .... ....... ......,
<br />�.
<br />RETENTIONS
<br />$
<br />WORKERS COMPENSATION
<br />PrECRa
<br />AND EMPLOYERS' LIABILITY YIN
<br />�_ UIfI:;,, ( EVEN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE ""
<br />E L, EACH ACCIDENT
<br />$
<br />OFFICERIM EMBER EXCLUDED?
<br />NIA
<br />-- - - — --
<br />----
<br />(Mandatory in NH)
<br />E.L., DISEASE - EA EMPLOYEE
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E L, DISEASE -POLICY LIMIT
<br />$
<br />C Professional / Pollution Liab CE0742012006
<br />01/01/2020 01/01/2021 Limit 10,000,000,
<br />I
<br />SIR 100.000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Proof of Insurance.
<br />%.CR 1 IrIVN1C nULUCR k ACWt+t.:tLLA I IUIV
<br />Superior Construction Co., Inc,
<br />1455 Louis Sullivan Drive
<br />Portage, IN 46368
<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
<br />of Marsh USA Inc.
<br />Manashi Mukherjee �Lauoo►-�
<br />9)1988-2016 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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