Opening of Quotations - Bowen Street Drainage Improvements Project No. 116-082A - HRP Construction Inc.

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AC40 �® CERTIFICATE OF LIABILITY INSURANCE ATE Da/�7/zo17YI 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 endorsement(s). PRODUCER CONTANAME: Stacy Christlieb Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 PHONE HONN E,ep. (800) 814-2122 l FAX NoF: (800)836-2122 E-MAIL s.schristlieb@gibsonins.comADDRES PO Box 11177 INSURERS) AFFORDING COVERAGE NAIL p INSURERAAmerisure Mut Ins Co 23396 South Bend IN 46601-0177 INSURED INSURER B : INSURERC: HRP Construction Inc. iNSURERD:- 5777 Cleveland Rd INSURER o- -- ---._ PO Box 266 INSURERF: South Send IN 46624-0266 COVERAGES CERTIFICATE NUMBER:9-1-16/17 RFVISICIN 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. INSR LTR '_......................... _.__,,,_�_�_ TYPE OF INSURANCE A D 5 $�0_R _____,_-✓____W_-- POLICY NUMBER POLICY EFF MMIDDlYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A = CLAIMS -MADE X OCCUR DAMAGE FO RENTEP PREMISES (Ea occurrence § 1,000,000 * MED EXP (Any one person) _ $ 10,000 XCU CPP20316441202 9/1/2016 9/1/2017 X Contractual_Liabil4y PERSONAL $ 1,000,000 _&ADVINJURY GENERAL AGGREGATE S 2,000,000 Gl- NTAGGREGATELIMITAPPLIESPER: POLICY X JECT LOC. PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident],,,_„�, S 1r � 000 000 _ BODILY INJURY (Per person) $ `A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS I.,..... rn70316451202 9/1/2016 9/1/2017 BODILY INJURY (Per accident) $ X WIRED AUTOS X NON -OWNED AUTOS PROPERtY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE .. $ 10 000 000 _1........_.._..c. AGGREGATE $ 10,000,000 EXCESSLIAB I CLAIMS -MADE $ �DED X I RETENTIONS 0 CU20316431102 9/1/2016 9/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X STATUTE ORTH E.L. EACH ACCIDENTENT $ 1 000 000 A. ANY PROPRIETORlPARTNERIEXECUTIVE OFFIC£RIMEMBER £XCLUO£0? (Mandatory In NHI NIA WC203164211 9/1/2016 I € 9/1/2017 -D'-'''� EL DISEASE - EA EMPLOYE ---'-'-"""'--- $ 1,00() 000 L" —..'-- It yas, descohe undar DESCRIPTION OE OPERATIONS below I States of IN t: MI E,L- DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Project: Bowen Street Drainage Improvements, 116-082A. Certificate holder is additional insured with respect to general liability coverages regarding work performed by the insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1316 County -City Building ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd. AUTHORIZED REPRESENTATIVE South Bend, IN 46601 r G SnS Agency/STACYC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 001401)