Agreement - Selge Construction Co - Donation of Transporting 7 Modular Bldgs from Ivy Tech to a City Location

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10 A " CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDb1YVYY) 3/8/2018 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. Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 PO Box 11177 South Bend IN 46601-0177 CONTACT Ellie Lloyd PHONE Ext): (800) 814-2122C No: (8001836-2122 E-MAIL elloy d@ ibsonins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A:Arner i sure Ins Co 19488 INSURED Selge Construction Co Inc 2833 S 11th St Niles MI 49120-4421 INSURERB:Travelers Prop Cab Co Of Amer 25674 INSURERC: INSURERD: INSURER E : 1 INSURER F : r.e)VP P ArrFa rI=QTIF:W.ATF NIIMRFR-8-31-17/18 Liability REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 1NSURANCE 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. IEXP LTR TYPE OF INSURANCE INSD WVDSUBR POLICY NUMBER MMIDDIIYEYYY MMfODYIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A � CLAIMS -MADE OCCUR L � 1 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 X MED EXP (Any one person) $ 10,000 XCU CPP20982400101 8/31/2D17 8/31/2018 X Contractual Liability PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 POLICY JEC LOG $ OTHER: AUTOMOBILE LIABILITY COEaMBI acciendZ'AIS GLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS CA20982410101 _ 8/31/2017 8/31/2018 BODILY INJURY (Per accident) $ PROPERTY eOPERT ntDAMAGE .. $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10, 000, 000 A EXCESS LIAR CLAIMS -MADE DED X RETENTION$ 0 $ CU20982430101 8/31/2017 B/31/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN EREXCLUDEO? OFFiCERiMEMA (Mandatory in (Mandatory€nNH} NIA WC209824401 11/31/2017 8/31/2018 XPER STATUTE ER - . E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Exceso Umbrella ZUP11ROOB5016NF 8/31/2017 0/31/2018 Each Occurance $13,000,000 Aggregate $13, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES {ACORD 101, Additional Remarks Schedule, may be allached If more space Is required) C`FRTIGITATF 41f11 nr-P CANCFLLATION (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 AUTHORIZED REPRESENTATIVE 227 W. c7efferson Blvd. Sough Bend, IN 46601 G Ins Agency/ELLIE ACORD 25 (2014101) 1 NS026 (201401) OO 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD