Award Quote - Walker Field House Restoration Proj No. 120-010R - Acculevel Commercial Group, Inc.

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AC"RO CERTIFICATE OF LIABILITY INSURANCE `� DATE(MMIDDIYYYY) 1 1/23/23 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 FF1288 BLEVINS INSURANCE AGENCY INC 803 S 18TH ST NAME: PHONE FAX IC No E /C No E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# LAFAYETTE, IN 4790S INSURERA : EIie Insurance Gom an 26263 INSURED ACCULEVEL COhTv1ERCIAL. GROUP INC 9495 N WALDRON RD ROSSVILLE, IN 46065-9552 INSURER B : Elie Insurance Property & Casually Company 26830 INSURERC : Elie Insurance Exchange 26271 INSURERD : Erie Insurance Company of New York 16233 INSURERE: Flagship City Insurance Com an 5585 INSURER F : COVERAGES CERTIFICATE NUMBER: NIA REVISION NUMBER: N/A 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 LTR TYPE OF INSURANCE A D INSD S WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS—hMA.DE X OCCUR X Q610231428 10/1/22 10/1/23 EACH OCCURRENCE $ 1,000,000 :4'J O RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENL AGGREGATE L IMIT APPLIES PER: POLICY �X ECT LOC OTHER: GENERAL AGGREGATE $ 2,000 000 PRODUCTS-COMP{OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTO ONLY AUTOS ONLY COMBINED N L LI I Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per a..dent $ $ C X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE Q34 0173534 10/1/22 10/1/23 EACH OCCURRENCE $ 2,000.000 AGGREGATE $ 2,000,000 DED X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) Ityes, describe under DESCRIPTION OF OPERATIONS below NIA 11/11 /22 11/11/23 07 H- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEq $ 500,000 E.L DISEASE -POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) PROJECT #120-010R PROJECT NAME: WALKER FIELD HOUSE RESTORATION PROJECT CITY OF SOUTH BEND 227 W JEFFERSON BLXrD SOUTH BEND, IN 46601 Ly_1CLai_;4gq! I091C1 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD