Opening of Bids - Spec W One of More 2017 or Newer Single Axle Dump Truck with Underbody Scraper - Trans Chicago Truck Group

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AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 8/16/2017 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 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 endorsements). PRODUCER CONTANAME: Paige Sexton Shepherd Insurance, T,T,C. PHONE ro,Ext):-_{317) 846-5554 - - - o)'. (317)845-5444 111 Congressional Boulevard AIL ADDRESS:PnooXton@shepherdirls.com Suite 100 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:AII America Insurance Co 20222 Carmel IN 46032 INSURED INSURER B :Central Mutual Ins 20230 INSURER C : TransChicago Truck Group INSURER D INSURERE: 2333 W 25th Ave INSURERF: Gary IN 46404 COVERAGES CERTIFICATE NUMBER:C116102850055 REVISION NUMBER: 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. Ob R POfDD EF PO/ ICY EXP ILTR TYPE OF INSURANCE lNqnPOLICY NUMBER V LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MA X OCCUR DAMAGE TO RENTED Pf2EMISES{Ea occurrence}___ $_ 300,000 GP 8877076 9/1/2016 9/1/2017 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO• LOC JECT X PRODUCTS -COMPIOPAGG $ 3,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS GP 8877076 9/1/2016 9/1/2017 NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS �Xd Par accident Limit: .. ..... . ......... . . . $ 1,000,000 Garage Liability X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5 000 000 DEO I X I RETENTION$ 0 $ CXS 8877075 9/1/2016 9/1/2017 WORKERS COMPENSATION IPER OT - AND EMPLOYERS' LIABILITY Y f N _ _..,_ STATUTE._.._.._... ER _...__ ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N l A E.L. DISEASE - EA EMPLOYE $ {Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Building Coverage CLP 6877074 9/1/2016 9/1/2017 Blanket Building Limit: 5,572,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Addlttonal Remarks Schedule, may be attached if more space Is required) Re: Bid Bond For: (1.) Freightliner Single Axle Plow Truck with Snow and Ice Removal Equipment per Specification Amount of Bond: 10% of Contract Amount H City of South Bend, IN 1308 County -City Building South Bend, IN 46601 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 ACORD 25 (2014101) INS026 (201401) Sexton/SFOUST ©1988-2014 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD