Opening of Bids - Main & Colfax Structure Repairs Proj No. 115-143BR - Pullman SST, Inc.

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— ® sec®�r® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 411 /2020 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 11311 McCormick Road, Ste 450 Hunt Valley MD 21031-8622 CONTACT NAME: Certificates Administrator PHONE 443-798-7499 FAX No): 443-798-7290 c ° A BW2.BSD.Certs a' .com -ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Ins Co Pittsbur h PA 19445 INSURED Pullman SST, Inc. 10150 Old Columbia Road INSURER B : New Hampshire Insurance Co 23841 INSURERC: XL Specialty Insurance Company 37885 Columbia, MD 21046 INSURER D : INSURER E : INSURER F : rrn11cDA1__ca r r-PTIF!C-ATE NIIMRFR- 1RArA97RFR REVISION NUMBER: 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. INS R LS TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD1YYYY EXP MM/DDY/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 6938932 7/1/2019 7/1/2020 EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any one person) $ 10,000 Contractual Liab X XCU PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS-COMP/OPAGG POLICY � PEA LOC _$4,000,000 OTHER: A AUTOMOBILE LIABILITY 2867423 7/112019 7/1/2020 COMBINED SINGLE LIMIT Ea accident $ 2 000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED IX NON -OWNED AUTOS ONLY AUTOS ONLY ROr PERTY DAMAGE $ $ C X UMBRELLA LIAB X OCCUR US00062096LI19A 7/1/2019 7/1/2020 EACH OCCURRENCE $10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE FN] OFFICER/MEMBEREXCLUDED? (Mandatory in NH) N / A 063724479 7/1/2019 7/1/2020 H X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COW IC-0503160 - Job #569563 - Main & Colfax Parking Structure Repair - 2020 City of South Bend is included as additional insured with respect to the general liability, automobile liability and umbrella liability policies as required by written contract. r'AAIr`FI I ATWIM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of South Bend, IN 227 West Jefferson Street South Bend IN AU HORIZEDREPRESENTATIVE ona U �aiS tS-L U"Ib fiI.VKU I.VKYVKAi IVIV. HII rlgtil5 IeJtli VCU. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD