Opening of Bids - Farmington Lift Station 14A Rehabilitation Project No 117-027 - HRP Construction Inc

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ACC)CERTIFICATE ®F LIABILITY INSURANCE DATE{MM1pDlYYYY) 8/28/2017 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(les) 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 CONTACT Ellie Lloyd NAME: y Gibson Insurance Agency, Inc. PHONE (800)814 2122 JpG,Nq) (800)836-2122 130 S Main St, Ste 400 E-MAIL ellsy d@gibsonins.com ADDRESS: PO Box 11177 INSURER{5) AFFORDING COVERAGE NAIC H South Bend IN 46601-0177 INSURER AAmerisur Mut Ins Co 23396 INSURED INSURER B : _ _-- - HRP Construction 5777 nstruction Inc. INSURER c -- Cleveland Rd INSURER 0.1 _ PO Box 266 INSURERE: South Bend IN 46624-0266 JINSURERF CnVFRAGFS CERTIFICATE NUMBFR-9-1-17/18 Liability 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. _ 7 - -- -- -- INSR ADDL SUER j POLICY EPF P01.1CYEXP -TYPE OF INSURANCE 1 LIMITS LTR 5 POLICY NUMBER MMlDD1YYYY MMfDplYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE l ^ I OCCUR lid I �AMAGETP RENTED'_._............ PREMISES Ea occurrence $ 1, 000, 000 X MED EXP (Any one person) $ 10,000 XCU CPP20316441202 9/1/2017 9/1/2018 X Contractual Liability PERSONAL SADVINJURY $ _ 1,000,,000^ AGGREGATE LIMIT APPLIES PER', GEN'L GENERAL AGGREGATE 5 2,000,000 POLICY I X € J; PRO- —1 LOC I PRgbUC7S_ COMPIOP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident} S 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO A BODILY INJURY (Per accidenl) $ --- ALL OWNED SCHEDULED AUTOS AUTOS CA20316451202 9/1/2017 9/1/2018 NOWOWNED X PROPERTY DAMAGE $ HIRED AUTOS, AUTOS Per accidera-...,.. X UMBRELLA LIAB X OCCUR EACH OCCURRENCE is 10,000,000 AGGREGATE 5 10 000 000 A EXCESS LlAB CLAIMS -MADE I DED X RETENTIONS 0 CU20316431102 9/1/2017 9/1/2018 $ WORKERS COMPENSATION X PER OTH. STATUTE__ ER,-,- AND EMPLOYERS' LIABILITY Y f N ANY PROPRIETORIPARTNERIEXECUTIVEN E.L. EACH ACCOENT $ 1,000, 000 A OrF10ERIMEMBER EXCLUDED? {Mandatory in NH) NIA WC20316421102 9/1/2017 9/1/2018 ------------- E.L. DISEASE - EA EMPLOYE - $ 1,000, 000 If yes, desulbe under DESCRIPTION OF OPERATIONS below States of IN 6 M1 ._..................... _. E.L- DISEASE - POLICY LIMI1 $ 1,000,000 €I E i DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schudulo, maybe attached if more space Is required], Certificate holder is additional insured with respect to general liability coverages regarding work performed by the insured. L:tK I Ih ILA I t_ MULL7tK LMIVL LLA I IUN (574)235-9171 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 1316 County -City Building 227 West Jefferson AUTHORIZED REPRESENTATIVE South Bend, IN 46601 G Ins Agency/E,LIE (0 1988-2(114 ACURL) U0HPURA I IUN. A!1 rights reserves. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 04€14011