Opening of Bids - One or More 2017 or Newer Single Axle 4x4 Dump Truck with Contractor Dump Bed Spec Z - Selking International Trucks

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A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/7/2017 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 endorsement(s). PRODUCER Shepherd Insurance, LLC. 111 Congressional Boulevard Suite 100 Carmel IN 46032 CONTACT Matt Smith _ NAME: W _ pHo Ems, ONE (317) 846-5554 pf� Nel. (3171846-5444 ADDRESS:msmith@shepherdins.com INSURERS AFFORDING COVERAGE NAIC q _ INSLIRERAA11 America Insurance Co 20222 INSURED DBA Selking International Decatur Truck & Tractor, Inc.International Selking Idealease 2807 Goshen Rd. Ft Wayne IN 46808 INSURERB:Central Mutual Ins 20230 INSURERC: INSURER D: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER:CL16122151782 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, INSRTYPE LTR OF INSURANCE ADDL SUER POLICY NUMBER NiMiooIYYEYYY MMIDDVY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR PPREMIDAMASESa aoe rencs $ 300,000 MED EXP (Any one person) $ 5, 000 GP 8883742 1/1/2D17 1/1/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 1,000,000 X POLICY PRO- LOC JECT PRODUCTS - COMPIOPAGG ....,.,..,.-,,. v $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY _ -X COEaMBINidenED t SINGLE LIMIT acc $ 1, D00, 000 _ BODILY INJURY (Per person) _ _ $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS GP 8883742 1/1/2017 1/1/2018 BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident $ NON —OWNED X HIRED AUTOS X AUTOS 1 $ 1,000,000 A X GARAGE LIAB GP 8883742 1/1/2017 1/1/2018 X UMBRE" LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE. $ 5, 000, 000 B EXCESS LIAB CLAIMS -MADE DED I X RETENTIONS 0 $ CXS 8883741 1/1/2017 1/1/2618 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORWARTNERIFXECUTIVE STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory (Mandatory in NH) E.L. DISEASE - FA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS belmv - - E.L. DISEASE - POLICY LIMIT $ A Physical Damage GP 8883742 1/1/2017 1/1/2018 Comploollision 1, 000/1, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requlredl Re: Bid Bond Contract Price $125,000 for Single Axle 4x4 Dump Truck Bond - 10% of Contract price ($12,500) Automatic additional insured for garage liability when required by written contract per attached 32807 0908. Subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of South Bend Board of Public Works 227 W. Jefferson Room 1316 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 tt Smith/TNICCU ACORD 25 (2014101) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD