Opening of Quotes - Century Center Upgrades & Renovation Project No 118-104A-R - Woodcox Building Contractor Inc

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WOODBLD-01 DH DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE .. _._.... ............... _.... 4✓22/2019 _.._.................�... _r 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(ies) must have ADDITIONAL INSURED provisions or 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 endorsements) w _...... PRODUCER COoNNTACT N(tNtE: 1st Source Insurance, Inc. PHONE ---_ 271- FAX 6909 Gra Road (Arc„ rro, Ext): (574) 271-5200 (A/C, No):(574) 271-5240 Mlshawa a, IN 46545 INSURER(S) AFFORDING COVERAGE, NAIC S INSURED Woodcox Building Contractor, Inc. 51175 Prescott South Bend, IN 46637 COVERAGES CERTIFICATE NUMBER: _REVISION NllMBE'R. 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 ppPOLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _._. w.POLICY NUMBER... A X COMMERCIAL GENERAL LIABILITY OLICY EXP LIMITS INS,R TYPE OF INSURANCE A'DDL SUaR POLICY EFF P EACH OCCURRENCE, s, 1,000,000 CLAIMS -MADE X (occuR �5D31186 5/22/2018 5/22/2019 DAMAGE TO RENTED _PREMISES (Ea 9 rrenaee) $ 500,000 MEP FXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X POLICY JECTPRO LOC �PRODUCTSGCOMP/OPAGG $ 2,000,0 0 G� N"{_AGGREGATE LIMIT APPLIES PER 00 AX (Ea MVB�INI�EfDi))SNGLE LIMITAUTOMOBILE LIABILITY nY $. 1,000,000 ANY AUTO 5E31186 5/22/2018 5/22/2019 OWNED SCHEDULED BO.OILY INJURY (Perperson) $ AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ AUTOS ONLY At�UT .i1.E tyAMAGE $ . A X EXCESS ABUMBRELLA �B X CLAIMSautADE ITmm WrWu5J31186 6/22/2017 IT^^^5/2212018 �AGGREGATERRENCE $ 2,000,000 DED X RETENTION $mmmmmmmmm 0 $ ANY PROPAND REORILRTNER/EXECUTIVE YIN% WCV6112029 5/22/2018 5/22/2019 ^TY E(,WEACHACCIDENTERH 500,000 B WORKERS ,yJ��'rICERIMEMBEREXCLUDED? y V N/A Mandat. y In NH) E L DISEASE - EA,EMPLOYEE $ 500,000 If yes, describe under 500 000 DESCRIPTION QF OPERATIONS below E.L DISEASE -POLICY LIMIT $ mmnnn"""" DESCRIPTION OFOXATONSLOCATIONS OTIS/VEHSL(ACON101,itIRatkSchedule, maybe attached if more space is required) rgaiOPERATIONS froO oris coverage. Project: Century Center Upgrades & Provsions The City of South Bend is additional insured regarding the General Liability and Auto Liability coverages when required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd. South Bend, IN 46601 _._ _.. .......- AUTHORIZED REPRESENTATIVE Cell lk AJA ( ) ....... ©1988-2015 ACORD CORPORATIONAll rights re ACORD 25 2016/03 . res erved. The ACORD name and logo are registered marks of ACORD