Opening of Quotes - 2021 Crack Sealing Proj No. 121-020 - Days Construction - Asphalt

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DAYSAS1 np In- PH .a�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) OF INSURANCE 05/10/2021 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(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 219-769-6616 Rothschild Agency, Inc 8979 Broadway Merrillville, IN 46410- Michael A. Kaim, CIC R -Comm) NC AD Michael A. Kaim, CIC PHONE219-769-6616 FAX (A/C, No, Ext): (AIC, No): E-MAIL INSURERS AFFORDING COVERAGE NAIC # INSURER A: West Bend Mutual 15350 INSURED Day's Construction -Asphalt Inc Robert Day dba INSURER B INSURER C : 855 Taft Street Gary, IN 46404 INSURER D INSURER E INSURER F --- -- — RCVIJIVIV I`IUIY16Cht: 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. II TR NSR OF INSURANCE ADDLITYPE ]Nqn WVn SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 2136639 10/05/2020 10/05/2021 EACH OCCURRENCE $ 1,000,000 PREMISES ( a occurrence) c $ 300,000 MED EXP (Any one arson $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a jE F� LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMITfEa entl $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS E AUTOS ONLY AUOTOS ONL� BODILY BODILY INJURY Per accident $ PerraccidenlDAMAGE A X UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE 2136639 10/05/2020 10/05/2021 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINA ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below I N / A 2135679 10/05/2020 10/05/2021 X PER OTH- LITE ER 1000,000 E.L. EACH ACCIDENT $ , E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 11000,000 A Equipment 2136639 10/05/2020 10/05/2021 Lsd/Rntd 45,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) STJ9007 ST JOSEPH COUNTY CITY OF SOUTH BEND 125 S LAFAYETTE, SUITE 100 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. REPRESENTATIVE 4.4wL AUUKU Lb tLU'Ib/UJ) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD