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�® <br />CERTIFICATE OF LIABILITY INSURANCE <br />/Y <br />DATE (MM/DDYYY) <br />7/16/2024 <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 />CONTACT <br />NAME: <br />The Horton Group <br />340 Columbia Place <br />PHONE FAX <br />A/c No Ext : 708-845-3917 A/c No): 866-202-5917 <br />ADDRESS: certificates@thehortongroup.com <br />South Bend IN 46601 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA: Amerlsure Insurance Company <br />19488 <br />INSURED C&EEXCA-01 <br />INSURER B: AmerlSure Mutual Insurance Co. <br />23396 <br />C & E Excavating of Delaware, Inc. <br />C & E Excavating, Inc. <br />INSURER C: Evanston Insurance Company <br />35378 <br />INSURER D : The Travelers Property Casualty Insurance Company <br />25674 <br />53767 CR 9 N <br />INSURERE: <br />Elkhart IN 46514 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1614372304 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 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICYNUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />CPP20978600901 <br />7/17/2024 <br />7/17/2025 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED PREM SES (Ea occurrrence <br />$1,000,000 <br />MED EXP (Any one person) <br />$10,000 <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />POLICY � PRO- � LOC <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />Y <br />Y <br />CA2097850901 <br />7/17/2024 <br />7/17/2025 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />B <br />D <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />CU20978621002 <br />EX-4Y434567 <br />7/17/2024 <br />5/30/2024 <br />7/17/2025 <br />7/17/2025 <br />EACH OCCURRENCE <br />$ 9,000,000 <br />AGGREGATE <br />$ 9,000,000 <br />DED X RETENTION $ n <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />Y <br />WC20978631102 <br />7/17/2024 <br />7/17/2025 <br />X STATUTE ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />A <br />Leased/Rented Equipment <br />IM20978610902 <br />7/17/2024 <br />7/17/2025 <br />Limit: $350,000 <br />Deductible: $1,000 <br />A <br />C <br />Installation Floater/Temp Storage <br />Pollution Liability <br />IM20978610902 <br />CPLMOL125133 <br />7/17/2024 <br />7/17/2024 <br />7/17/2025 <br />7/17/2026 <br />Jobsite: $75,000 <br />Limit: <br />Storage: $30,000 <br />1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Additional insured on a primary and non-contributory basis with respect to the General Liability and Automobile Liability only when required by written contract. <br />Waivers of subrogation applies to the General Liability, Automobile Liability and Workers Compensation in favor of the stated additional insureds only when <br />required by written contract. Umbrella Follows Form on the referenced General Liability, Automobile Liability and Workers Compensation policies. <br />CERTIFICATE HOLDER CANCELLATION <br />C&E Excavating <br />53767 Co Rd 9 <br />Elkhart IN 46514 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />