Opening of Bids - Seitz Park Reconstruction Phase I Proj No. 117-093A - Northern Indiana Construction Co., Inc.

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ACORU® CERTIFICATE OF LIABILITY INSURANCE 08/26/20220 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(les) 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 1-414-443-0000 Hays Companies 1200 North Mayfair Road, Suite 100 CONTACT NAME: PHONE FAX C No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: NATIONAL FIRE & MARINE INS CO 20079 Milwaukee, WI 53226 INSURED INSURERB: BERKLEY NATL INS CO 38911 Pierce Manufacturing Inc. INSURER C INSURERD: P.O. Box 2017 INSURER E : INSURERF: Appleton, WI 54912-2017 COVERAGES CERTIFICATE NUMBER: 60066011 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. fNSR LTR TYPE OF INSURANCE 1=SUER POLICY NUMBER MM/DDPOLICYEFF MM/DD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY X 42—GLO-100190-06 04/01/20 04/01/21 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FKOCCUR DAMAGE T RE PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 JECOT PR ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A X UMBRELLALIAB rd OCCUR 42—UMO-100191-06 04/01/20 04/01/21 EACH OCCURRENCE $ 15,000,000 EXCESSLIAB CLAIMS -MADE AGGREGATE $ 15,000,000 DIED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Excess Liability CEX09600174-07 04/01/20 04/Ol/21 Ea Occ/Agg 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) Additional Insured when required by written contract between the owner and a Pierce Dealer. Two (2) Pierce Enforcer Pumpers FICATE HOLDER City of South Bend 1045 West Samle Street South Bend, IN 46619 ACORD 25 (2016/03) kguell cnn.c I USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD