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CERTIFICATE OF LIABILITY INSURANCE
<br />#16..,10/10/2022
<br />DATE (MMIDDIYYYY)
<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
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR 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.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />HANE David S Parrilll
<br />Parrilli, David
<br />,AugPHOme
<br />Noext,(312)621-5182 Nc Naz (312)621-2288
<br />E' A L dparrilli@rockwoodco corn
<br />ADDRESS:
<br />The Rockwood Company
<br />INSURER S) AFFORDING COVERAGE NAIC N
<br />20 N Wacker Drive, Suite 600
<br />INSURERA : Navigators Specially Ins Co. 36056
<br />Chicago IL 60606
<br />INSURED
<br />INSURER B: Slarstone National Insurance Co. 25496
<br />INSURER C: Hallmark Specially Insurance Co- 26808
<br />Green Demolition Contractors, Inc
<br />INSURER 0:
<br />4840 S St Louis Ave Ste 100
<br />INSURER E:
<br />CLAIMS -MADE X OCCUR
<br />1 INSURER F
<br />Chicago IL 60632
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS 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
<br />THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />TYPE OF INSURANCE
<br />IMI
<br />POLICY NUMBER
<br />(iYl __0lYYYY
<br />[MAfR]EHYYYYJ_
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE X OCCUR
<br />PREMl4 SjEaosrur¢ae¢}
<br />$ 50,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />A
<br />X
<br />X
<br />CE22CGL1326961C
<br />10101/2022
<br />10/01/2023
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN,, AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ®PRG ❑ Loc
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER
<br />AUTOMOBILE LIABILITY
<br />IEa 4c[10atHS L LIMI1
<br />$ 1,000,000
<br />BODILY INJURY (Per personl
<br />$
<br />ANY AUTO
<br />A
<br />OWNED SCHEDULED
<br />X
<br />X
<br />CE22CGL1326961C
<br />10/01/2022
<br />10/01/2023
<br />BODILY INJURY (Per accidw L)
<br />$
<br />AUTOS ONLY AUTOS
<br />PRO'ER1YtMMAQE
<br />I Nor Iden
<br />$
<br />NON -OWNED
<br />HIRED rx
<br />AUTOS ONLY AUTOS ONLY
<br />$
<br />X
<br />UMBRELLA LIAR X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />B
<br />7
<br />EXCESS LIAR
<br />CIAIMS-MADE
<br />59095B22AALI
<br />10/0112022
<br />10101/2023
<br />DFs JX RETENTION S 10.000
<br />$
<br />_
<br />WORKERS COMPENSATION STATUTE
<br />EFIH
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETOR/PARTNER/EX ECUTIVE E -L EACH ACCIDENT
<br />$
<br />OFFICER/MEMBER EXCLUDED? ❑ NIA
<br />(Mandatory In NHI E.L DISEASE - EA EMPLOYEE
<br />S
<br />It yes, describe under
<br />DESCRIPTION OF OPERATIONS below F.L DISEASE- POLICY LIMIT
<br />$
<br />Each Occurrence
<br />5,000,000
<br />Excess Umbrella Liability
<br />C 79EX-000708922-00 10101/2022 1010112023 Aggregate
<br />5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: 7042 Lanphier High School - Additions and Renovations - 1300 N 11 th St, Springfield, IL 62702
<br />Additional insureds with respect to General Liability and Hired & Non Owned Auto Liability (Umbrella follows form) on a Primary & Non Contributory basis
<br />when required by
<br />written contract per ISO Forms CG 2010 10/01 and CG 2037 10/01 (attached) for work performed by Green Demolition Contractors, Inc. A Waiver of Subrogation in favor of
<br />Additional Insureds with respect to General Liability and Hired & Non Owned Auto Liability (Umbrella follows form) when required by written contract is included
<br />per ISO form CG
<br />2404 (05/09):
<br />Harold O'Shea Builders, Inc (GC), Springfield Public School District 186 (Owner); and BLDD (Architect)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Harold O'Shea Builders, Inc ACCORDANCE WITH THE POLICY PROVISIONS.
<br />General Contractor
<br />AUTHORIZED REPRESENTATIVE
<br />3401 Constitution Drive
<br />w'
<br />Springfield IL 62711
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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