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

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ACOR©° CERTIFICATE OF LIABILITY INSURANCE #*./ II/I/2020 DATE(MWDD/YYYY) 1 8/26/2020 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(a). PRODUCER LOCKTON COMPANIESCONTACT 5500 Wayzata Blvd., Suite 510 Minneapolis MN 65416 763-512-8600ADDRESS: A/c Na Ext : FAX No): EMAIL 25615 INSURER A : The Charter Oak Fire Insurance Company INSURED MACQUEEN EQUIPMENT, LLC 1432884 DBA MACQUEEN EMERGENCY GROUP 1125 E. 7TH STREET ST. PAUL MN 55106 INSURERB: The Travelers indemnityContpanyofConnecticut 25682 INSURERC: Travelers Property Casualty Co ofAmenca 25674 INSURER D INSURER E: INSURER F, COVERAGES CFRTIFICOTF NI/MRFR- 16927i71 RFVIR1nN NI lIMRFR- XXXXXXX 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY Y N 630-867K8328 11/1/2019 H/1/2020 EACH OCCURRENCE s 1,000,000 CLAIMS -MADE � OCCUR PRMMI ES (EaEoccurrence) s 300,000 MED EXP (Any one arson 15,000 PERSONAL & ADV INJURY $ 1 000 000 GENT AGGREGATE LIMIT APPLIES PER. POLICY � PRo FX LOG GENERAL AGGREGATE $ 2 00O 000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY N N 810-7N364433 11/I/2019 11/1/2020 OMaBItI DISINGLE LIMIT $ 1 000 000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX AOUTOSONLY AUTOSULED BODILY INJURY (Per accident s XXXXXXX AUTOS ONLY NON-OWNED ONL� Per acEcRld. DAMAGE $ XXXXXXX $XXXXXXX C UMBRELLA LIAB X OCCUR Y N CUP-OK231444 11/1/2019 I I/I/2020 EACH OCCURRENCE $ 10000,000 AGGREGATE S 1 O 000 000 NX EXCESS LLAB CLAIMS -MADE DED I X I RETENTION $ 10,000 $ XXXXXXX 1 A WRKERION AND EMPLOERS'LIACOPESBILIITY Y/N OFFICEWMEMSER EXCLUDED?ANY CUTIVE rN7 (Mandatory in NH) DESCRIPTION OF OPERATIONS helaw N / A N UB-OL654504 11/1/2019 II/1/2020 X I STATUTE OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMI7 1. I UOO OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) THE CITY OF SOUTH BEND IS LISTED AS ADDITIONAL INSURED ON GENERAL AND UMBRELLA LIABILITY AS REQUIRED BY WRITTEN CONTRACT SUBJECT TO POLICY TERMS, CONDITIONS, AND EXCLUSIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE SHALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. %.mrc I rrwA 1 tc nvwcrc L ANIiCLLA 1 IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16927571 AUTHORIZED REPRESENTATIVE The City of South Bend 1045 West Sampple Street South Bend IN 46619 ACORD 25 (2016/03) ©1 8-2015 ACORD CORPORATION. All riahts reservad The ACORD name and logo are registered marks of ACORD