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<br />CERTIFICATE OF LIABILITY INSURANCE 08/27/2019
<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 rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CAON �TACT Danielle Hunt
<br />Gibson Insurance Agency, Inc.. PPHHCON a Ex (800) 814-2122 Nm (800) 836-2122
<br />IT
<br />130 S Main St, Ste 400 E-MAIL ADDRESS: dhunt@gibsonins,com
<br />SUR INER(S)AFFOR
<br />PO Box 11177 DING COVERAGE NAIC #
<br />South Bend IN 46601-0177 INSURERA: Amerisure Mut Ins Co 23396
<br />INSURED INS_UR_ER B
<br />HRP Construction Inc. INSURERC�:
<br />,..�.................. ..........
<br />5777 Cleveland Rd INSURER D
<br />POBox 266_....�..._._.............._.........._.....__.........
<br />INSURER E :
<br />South Bend IN 46624-0266 INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 9-1-19/20 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 MAYBE 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 />LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
<br />"............ ....................._._._............. ..,...._."u....__ ...
<br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />=9tmisrs orriaaa $ 1,000,000 �
<br />CLAIMS -MADE OCCUR reREM;S�,,
<br />X XCU MED EXP (Any one person) $ 10,000
<br />...__.....__ ................................................
<br />A X Contractual Liability CPP20316441502 09/01/2019 09/01/2020 PERSONALBADVINJURY $ 1,000,000
<br />GEN'1AGCIREGA11 LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000
<br />POLICY N JECT 0 LOG PRODUCTS -COMPIOPAGO $ 2,000,000
<br />OTHER: $
<br />GtMNINEDSINGLELIMII .._..�.1,
<br />AtAT(1MOBILELAB3ILGTY $ 000000
<br />E,a mNGCaR09gBq)
<br />X ANY AUTO BODILY INJURY (Per person) $
<br />A OWNED SCHEDULED CA20316451502 09/01/2019 09/01/2020 BODILY INJURY (Per accident) $
<br />AUTOS ONLY AUTOS
<br />r
<br />'RR1k "t RT f 9J IMAGE $
<br />AUTOS ONLY qX
<br />AUTOS ONII..Y FH,1r +,rcGodoink; _W....,",,,,, „,,, ,�„
<br />HIRED NON OWNED FY " "�� _�.
<br />$
<br />._"............. ...__............ ....... _...
<br />_ ....._........ _.
<br />X UMBRELLA LIAB X OCCUR �A"ACH OCCURRENCE $ 10,000,000
<br />A EXCESS LIAB CLAIMS -MADE CU20316431402 09/01/2019 09/01/2020 REGATE $ 10,000,000
<br />DED X RETENTION $ ® $
<br />..._ ....�.....�........................._._..�,.�.._.._. ..
<br />WORKERS COMPENSATION PER OTH _,_,_,
<br />AND EMPLOYERS' LIABILITY YIN X .STATUTE I ER _
<br />1 000,000
<br />A ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WC203164214 09/01/2019 09/01/2020 E L EACH ACCIDENT $ _
<br />OFFICERlMEMBER EXCLUDED?
<br />(Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />L..� ............... ... ...... ................................ ......
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />City of South Bend Board of Public Works
<br />227 West Jefferson, 13th Floor
<br />South Bend
<br />IN 46601
<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 />@ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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