Opening of Quotations - West Race Emergency Repair Proj No 115-115 - HRP Construction Inc

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ACCORhIr CERTIFICATE OF LIABILITY INSURANCE �� FDATE(MMIODIYIYY) 4/18/2018 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 CONTACT Ellie Lloyd NAME Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 PHCNN Ex€. (800) 814-2122 FAX AIC No: (800)936-2122 ADDRIESS,elloyd@gibsonins.com INSURERS AFFORDING COVERAGE NAIC it PO Box 11177 INSURER A:Amerisure Mut Ins Co 23396 South Bend IN 46601-0177 INSURED INSURER B INSURERC: HRP Construction Inc. 5777 Cleveland Rd INSURERD: PO Box 266 INSURERE: South Bend IN 46624-0266 1 INSURERF; COVERAGES CERTIFICATE NUMBER:9-1-17/18 Liability I2EVISInM NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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. tLNTR TYPEOFINSURANCE ADDL WVD S POLICY NUMBER MMIDDPOLICIYYYY EFF MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE I —XI OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 11000,000 X MED EXP (Any one person) $ 10,000 XCU CPP20316441202 9/1/2017 9/1/2018 X Contractual Liability PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICYJEC F]LOC GENERAL AGGREGATE $ 2,000,000 GENT PRODUCTS -COMPIOPAGO S 2,000,000 S OTHER: AUTOMOBILE LIABILITY COMBINEI SINGLE LIMIT Ea accident $ 1,0001000 BODILY €NJURY (Per person) $ A Ix ANY AUTO AUTOS SCHEDULED AUTOS AUTOS CA20316451202 9/1/2017 9/1/2018 BODILY INJURY (Per ( ) -PROPERTY $ NON -OWNED HIRED AUTOS X AUTOS ntDAMAGE $ S X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,00o AGGREGATE S 10, 000, 000 A EXCESSLIAB CLAIMS -MADE DEb J X I RETENTIONS 0 $ CU20-116431102 9/1/2017 9/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 A ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC20316421102 States of IN & MI 9/1/2017 9/1/2018 E.L. DISEASE - EA EMPLOYE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ 1, 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Project Name: West Race Emergency Repair. Project No: 115-115. Certificate holder is additional insured with respect to general liability coverages regarding work performed by the insured. CERTIFICATE HOLDER CANCEL[ ATION 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 West Jefferson Blvd. South Bend, IN 46601 G Ins Agency/ELLIE U 1UBB-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)