Opening of Proposals - CMc for Madison Lifestyle New Parking Garage Proj No 123-074 - Shiel Sexton

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Madison Lifestyle District - CMc RFP Response • Shiel Sexton | 26Confidential material included on this page. NON-COLLUSION FORM INSR ADDL SUBRLTRINSRWVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME:FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Nat'l Union Fire Ins Co Pittsburgh PA XL Specialty Insurance Company New Hampshire Insurance Company AGCS Marine Insurance Company National Trust Insurance Company 8/30/2024 EPIC Insurance Midwest P.O. Box 80159 Indianapolis, IN 46280 Christopher Ensminger 317-706-9594 christopher.ensminger@epicbrokers.com Shiel Sexton Company Inc. MBA Leasing, Inc. 902 N. Capitol Avenue Indianapolis, IN 46204 19445 37885 23841 22837 20141 A X X X X X 3118753 09/01/2024 09/01/2025 2,000,000 300,000 10,000 2,000,000 4,000,000 4,000,000 E X X X X X CA10008702801 09/01/2024 09/01/2025 2,000,000 B X X X 0 US00143222LI24A 09/01/2024 09/01/2025 10,000,000 10,000,000 C N X 011326634 09/01/2024 09/01/2025 X 2,000,000 2,000,000 2,000,000 D Leased & Rented Equipment MXI93093022 09/01/2024 09/01/2025 $1,000,000 Per Item $5,000 Deductible The General Liability policy provides Additional Insured status including Completed Operations and Waiver of Subrogation if required by written contract. The General Liability policy is Primary and Non-Contributory if required by written contract. The Auto Liability policy provides Additional Insured status and Waiver of Subrogation if required by written contract. The Auto Liability policy is Primary and Non-Contributory if required by written contract. The Workers Compensation policy provides a Waiver of Subrogation if required (See Attached Descriptions) For Information Only 1 of 2#S6882172/M6880615 SHIESEX1Client#: 31918 RRI01 INSURANCE & BONDING