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

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AC40R n) CERTIFICATE 4F LIABILITY INSURANCE ° /a�e/a0WYYY a ) 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, EXTENT] 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). PRODUGER NAME CT Ellie Lloyd Gibson Insurance Agency, Inc. At1-01 ER . (800) 814-2122 All No:(800)836-2122 130 S Main St, Ste 400 ADDRESS: elloyd@gibsonine.com AQDRE INSURERS AFFORDING COVERAGE NAIC q PO Box 11177 INSURER A;Amerisure Mut Ins Co 23396 South Bend IN 46601-0177 INSURED INSURER B: INSURERC: URP Construction Inc. INSURERQ: 5777 Cleveland Rd INSURERE: PO Sox 266 INSURERF: South Bend IN 46624-0266 COVERAGES CERTIFICATE NUMBER: 9-1-17/l8 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. INSR LTR TYPE OF INSURANCE ADDL SUBR mBa POLICY NUMBER POLICY EFF MMfDDlYYYY POLICY EXP MM(DDIYYYY LIM1IITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.,000,000 A CLAIMS -MADE OCCUR OA A T RENTED PREMISES Ea occurrence 5 1,000,000 X MEDEXP(Anyoneperson) $ 10,000 XCU CPP20316441202 9/1/2017 9/1/2018 X Contractual Liability PERSONAL SADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X 210i El LOC PRODUCTS -COMPlOPAGG S 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SENGLt: LIMIT Ea acadent 5 1,000,000 BOD€LY INJURY (Per person) S A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CA20316451202 9/l/2017 9/1/2018 Ix BODILYINJURY(Peracldeal) S PPROaPdTYIDAMAGE S HIREDAUTOS AU OSED S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 5 10, 000, 000 AGGREGATE S 10, 000, 000 A EXCESS LIAR CLAIMS -MADE DEO I X RETENTIONS 0 $ CD20316431102 9/1/2017 9/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X PER OTn STATUTE I ER E.L. EACH ACCIDENT S 11000,000 A ANY PROPRIETORIPARTNERfa_XECUTIVE MandatoMlnNH FJ(CLUOEO7 I rY ) N!p' WC20316421102 9/1 2017 / 9/l/2018 E.i..DISEASE -EA EMPLOYE $ 11000,000 Ityes,descAbeunder DESCRIPTION OF OPERATIONS below States of IN & MT E.L, DISEASE. POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS ) LOCATIONS! 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. City of South Bend Board of Public Works 1316 County City Building 227 West Jefferson Blvd. South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ins Agency/ELLIE ©1988-2014 ACORD CORPORATION. All riahls reserved_ ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)