Opening of Qualifications - Lead Hazard Reduction Program Pre-Qualified Contractors RFQ - House Doctor Renovations

Home Browse Search

AC®R®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YWY) 03/18/2021 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 CONTACT NAME: Mark Mondientz NE AIC. No, EXt : (574)277-5511 AIX No): (574)277-3707 Hoffman Insurance Group, Inc. E-MAIL ADDRESS: marm hi a en ADDRESS: C� 9 9 cY.com 52513 Gumwood Rd. INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 INSURER : Indian Harbor Insurance Co. Granger IN 46530 INSURED INSURERB : Erie Insurance Exchange INSURER C : House Doctor Renovations (dba) Barney Lee Brooks INSURER D : Liberty Mutual I nsruance Co. 1506 O'Brien Street INSURER E AUTOMOBILE LIABILITY ANYAUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY INSURER F South Bend IN 46628 COVERAGES CERTIFICATE NUMBER: 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. INSRPOLICY LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER EFF IMMIDDIYYYYI POLICY EXP IMMIDDIYYYYILIMITS A X COMMERCIAL GENERAL LIABILITY �/ CLAIMS -MADE X OCCUR N N 1300103075 10/01/20 10/01/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER : X POLICY ❑ PRO JECT F—] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY N N Q051131029 05/11/2020 05/11/2021 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEREXECUTIVE Y!N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A N WC5 395 748940 01 0 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 FE . DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION South Bend Board of Public Works 227 West Jefferson Blvd South Bend, IN 46601 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 Fax: EmaiLbpwbids@ southbendin.gov © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD