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Client#: 850949
<br />KILARCHI
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />1 5/06/2020
<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 />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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />USI Ins Srvcs LLC Euclid -Prof
<br />PHONE 312 442-7200 FAX 610 362-8900
<br />MA Lo, Ext : (A/C, No):
<br />2021 Spring Road, Suite 100
<br />ADDRESS: Tere.Holmes@usi.com
<br />Oak Brook, IL 60523
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />312 442-7200
<br />Twin City Fire Insurance Company
<br />INSURER A: Y P y
<br />29459
<br />INSURED
<br />INSURER B : Trumbull Insurance Company
<br />27120
<br />Kil Architecture & Planning
<br />RLI Insurance Company
<br />INSURER C : p y
<br />13056
<br />1126 Lincoln Way East
<br />South Bend, IN 46601
<br />INSURER D
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 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 MAY BE 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
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />NSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [* OCCUR
<br />83SBWAD1109
<br />03/23/2020
<br />03/23/2021
<br />EACH OCCURRENCE
<br />$1 ,000,000
<br />PREMISESOEa occurrDence
<br />$1 ,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL & ADV INJURY
<br />$1 ,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />POLICY X JECT LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$2,000,000
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />83SBWAD1109
<br />03/23/2020
<br />03/23/2021
<br />(CEO, aBc,den SINGLE LIMIT
<br />$1 ,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLA LAB
<br />EXCESS LAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />83SBWAD1109
<br />03/23/2020
<br />03/23/2021
<br />EACH OCCURRENCE
<br />$5 OOO 000
<br />AGGREGATE
<br />s5,000,000
<br />DED X RETENTION $1 O 000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER EXCLUDED? N]
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />83WEGADOSWV
<br />03/23/2020
<br />03/23/2021
<br />X STATUTE EORH
<br />E.L. EACH ACCIDENT
<br />$1 ,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1 ,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />1 $1 ,000,000
<br />C
<br />Professional
<br />Liability
<br />RDP0035746
<br />03/23/2019
<br />03/23/2021
<br />$1,000,000 Each Claim
<br />$2,000,000 Annual Aggr.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Professional Liability is written on a 'claims made' policy form.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Board of Public Works, City of
<br />South Bend, IN
<br />1316 County -City Building
<br />227 W Jefferson Blvd
<br />South Bend, IN 46601-1830
<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 />ACORD 25 (2016/03) 1 of 1
<br />#S28725186/M28512369
<br />64..)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />TXHAQ
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