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Opening of Quotes - Water Works Utility Service Line Repair Program Proj No. 122-022 - Bob Frame Plumbing Services, Inc.
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Opening of Quotes - Water Works Utility Service Line Repair Program Proj No. 122-022 - Bob Frame Plumbing Services, Inc.
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1/11/2022 3:30:55 PM
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Board of Public Works
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Projects
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1/11/2022
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A4CCW? 6r CERTIFICATE OF LIABILITY INSURANCE <br />DAT02111/2021 <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 BELOW. THIS <br />CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR <br />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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder In lieu of such entlorsement s . <br />PRODUCER <br />FEDERATED MUTUAL INSURANCE COMPANY <br />HOME OFFICE: P.O. BOX 328 <br />CONTACT <br />E: CLIENT CONIACT CEN ER <br />n/cnxo Ext : 888-333-4949 AIX No); 507A46-4664 <br />ADDRIESS: CLIENTCONTACTCENTER FEDINS.COM <br />OWATONNA, MN 55060 <br />INSURER($) AFFORDING COVERAGE MAIC R <br />04/01/2021 <br />INSURERA: FEDERATED MUTUAL INSURANCE COMPANY 13935 <br />EACH OCCURRENCE $1,000,000 <br />INSURED 264-429-2 <br />INSURER B: <br />BOB FRAME PLUMBING SERVICES INC <br />2442 JACLYN CT <br />INSURER C: <br />- - <br />INSURER D: <br />SOUTH BEND, IN 46614-3700 <br />INSURER E: <br />OENERAL AOOREOATE $2,000,000 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 22 REVISION NUMBER:0 <br />THIB 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 CONTRACT OR 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, EXCLUSIONS <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />L <br />TYPE OF INSURANCE <br />ADDL <br />Y <br />SUBR <br />- <br />POLICY NUMBER <br />POLICY EFF <br />IOD <br />POLICY EXP <br />IDD <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMSMAOElxl OCCUR <br />N <br />9403507 <br />04/01/2021 <br />04/01/2022 <br />EACH OCCURRENCE $1,000,000 <br />PREMISES TOEa ocwr0renoel $100,000 <br />OEN'L <br />1t <br />NPOLICY <br />MED EXP (my one Parton) EXCLUDED <br />PERSONAL &ADV INJURY $1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />❑JECT ❑LOC <br />OTHER: <br />OENERAL AOOREOATE $2,000,000 <br />PRODUCTS - COMPIOP HOG $2,000,000 <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED AUTOS ONLY AUTOSULED <br />NON-OHIRED AUTOS ONLY AUTOS ONLY <br />AUTOS ONLY <br />N <br />N <br />9403507 <br />04/01/2021 <br />04/01/2022 <br />COMBINED SINGLE LIMIT $1,000,000 <br />Ea ac<Ide <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per eoddenq <br />PROPERTY DAMAGE <br />a ec<dent <br />A <br />X <br />UMBRELLA LIARX <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />N <br />N <br />9403508 <br />04/01/2021 <br />04/01/2022 <br />EACH OCCURRENCE $2,000,000 <br />AGGREGATE $2,000,000 <br />DED I I RETENTION <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOFIPARTNERIEXECUTIVE L <br />OFFICER/MEMBER Exctuoeoy <br />(Merelst.y in NH) <br />II yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />N <br />9403509 <br />04/01/2021 <br />04/01/2022 <br />OTH- <br />X PER bTATUTE ER <br />E.L. EACH ACCIDENT $500,000 <br />E.L. DISEASE - EA EMPLOYEE $500,000 <br />El DISEASE -POLICY LIMIT $500,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addl0one1 RemeMs Schedule, may be alheheL it more space Is requlred) <br />THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES <br />OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. <br />CERTIFICATE HOLDER CANCELLATION <br />264-429-2 <br />220 <br />CITY OF SOUTH BEND <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />227 W JEFFERSON BLVD <br />THE EXPIRATION DATE THEREOF, NOTICE <br />WILL BE DELIVERED IN <br />SOUTH BEND, IN 46601-1830 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />O 1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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