Laserfiche WebLink
C"RO CERTIFICATE OF LIABILITY INSURANCE DATE <br />3/1/2018 ) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />NAME Karen Wallace <br />The De ayes Group PHONE karemTw deha es rom y FA t _ <br />5150 West Jefferson Boulevard E-MAIL NCI 2tr0-969 8994 <br />Fort Wayne IN 46804 _�pOft S, „ y_„ <br />INSURER(S) AFFORDING COVERAGE _ NAIC #__ <br />INSURER A: EMC Property and Casualty Insurance Com <br />pany,", 25186 <br />INSURED ORTMDRI-01 <br />INsuRERe: <br />Ortman Drilling, Inc. <br />241 North 300 West INSURER c <br />Kokomo IN 46901-3984 INSURER D: <br />INSURER E : <br />GUVtKAU= IaKIIt-ILA It NUMOLK: 1bbbb[ti(Zb Ktvr,51UN NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES" LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,. <br />LTR TYPE OF INSURANCE........ POLVC'Y NUMBER ._-PO i'YYYY MMIO <br />INSR .. ADDL'Ufd't ......., _-POLICY EF _._....... ..,,.... .. _ ........... <br />930 <br />unw <br />F Pwfip M LWITS <br />A X COMMERCIAL GENERAL LIABILITY 5X0 41 18 17 3/1/10111 3/1/1019 EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE (X .� OCCUR YAMKISC7 YiL' E0 <br />PREMISES (Ea occurrence) $ 100,000 <br />PERSONAL A& ADV INJURY III $ <br />GE AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ <br />N'L <br />PRO <br />POLICY y X p(',C"9 .J LOG <br />PRODUCTS-COMP/OP AGO $ <br />X OTHER: XCU not excluded <br />$ <br />AUTOMOBILE LIABILITY <br />5X04118 <br />3/1/2018 <br />3/1/2019 <br />L^9DIr1al(wEDsN.aLELIMNi' $ <br />`kEa acctdenbl... <br />X.. ANY AUTO <br />BODILY INJURY (Per person) $ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />PRC4r'FPfY11 <br />X HIREDAUTOS X.. AUTOS <br />yDqAMA("&E $ <br />Pef E44�.G�.P1C4;C,U .. <br />$ <br />A <br />X UMBRELLA LIAB X OCCUR <br />5X0 41 18 17 <br />1111201/ <br />3/1/2019 <br />EACH OCCURRENCE $ <br />EXCESS LIAB CLAIMS -MADE <br />AGGRFCdATE .R <br />q <br />WORKERS COMPENSATION <br />5X0411817 <br />3/1/2018 <br />3/1/2019 <br />ERH <br />AND EMPLOYERS' LIABILITY YIN <br />-X',STATIJTE,,.�..... C <br />- <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />N / A <br />E L EACH ACCIDENT $ 1.000 00( <br />- .em-._._--- .,„, ........ <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00( <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />EL. DISEASE - POLICY LIMIT $ 1,000,00( <br />A <br />Nand Marine <br />5X0411817 <br />3l1/2018 <br />3/1/2019 <br />LeaseWRented Equip 120000 <br />Inland Marine <br />tastMlatien Floater 150:000 <br />Pollution Liability <br />I Unill $500,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) <br />CERTIFICATE HOLDER CANCELLATIOIN. <br />City of South Bend Dept of Public Works <br />1316 City County Bldg <br />South Bend IN <br />USA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />