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CONSTRUCTION
<br />Selge Construction South Bend GESC 2019
<br />Insuraaaa� Certificate
<br />ACOIR& CERTIFICATE OF LIABILITY INSURANCE DAT 08/23l23/12018 )
<br />018
<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 />BELOW. 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRWUCER.... tlO,a1NRC4 EII1ML.loyd
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<br />Gibson Insurance Agency, Inc. Pe1oNE (800) 814 2122 (81X4 wz ,t1 7
<br />130 S Main St, Ste 400 A,0004 ,... MlOyddftil.'rarrcr116na,c^eam
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<br />PO Box 11177 INSURERS AFFORDING COVERAGE NAICN
<br />South Bend IN 468W-01W INSURERA: AmerisurelnsCo 19488
<br />. ..,,.........�.. .......................... ............,.....�._..,. ._� ,._ .._.
<br />te4SURELd INSURERS, Tca"Yelam Prop Cos Coal Amer 256.174..
<br />Selge Construction Co Inc IRSURER c
<br />. . ........................... .......... .... ...,..
<br />2833 S 111h St INstrnrrl rl
<br />................
<br />INSURER E:.
<br />Niles MI 49120.4421 JIN%AtRF..
<br />COVERAGES CERTIFICATE NUMBER: 5-31.1&19'l.iAWny REViISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE h"CIOCl F^'F C li""1SURJO�,,s B,,GrFP rI BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE P(,M1 Iq Y PFIRKID
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />1 t TYPE OF INSURANCEICY EX0
<br />yy POLICY NUMBER... M VyYY"y M LOM"YY.j. .....LIMITS
<br />7.OiAfi1'WbSCI" WtI. OENSRAL LIA84l.n'y 1,000.000
<br />hhl r 1y^.:.tLI'�178 &',eAO�T $
<br />' 1.000,000
<br />CLAIMSMADE N OCCUR PR Ml$ 5 Ea eoc- i E
<br />XCU A1FO FxP,A+, +oven. ,W 10,000
<br />A X ContractualLiabilily CPP20982400201 08/31/2018 06/31/2019 PFRSONAI.RAOVIN,JURY s 1.000,000
<br />OhPri e,t,r R8.ti 1pt?LI91E'IY d"+l+ti"UiUn"PER: a'.v...rdR,°l lr,L AQm+"wNE1';iu4t"F. S 2000000
<br />POLICY JET LOC PROn11r,.TS_COMPgPAOG S 2,000,tl0G
<br />OTHF'R S
<br />AUTOMOBILE LIABILITY CAN 1PM^RU'Yx'J'CS4 r orm, 5 1.000.000
<br />..N ANYAUTO ........, BODILY INJURY [Pe pe ).
<br />A CA20982410201 0813112018 0813V2019 BODILY wdu RY(Pe aide_ ^ OWNED SCHEDULED accident) S
<br />i,„„„,,,,, AUTOS ONLY AUTOS .....
<br />+ F t I r .______-
<br />+ '* AUTOHIRES ONLY +°" ". AUTOS ONLY t'RI rx rr�NAV i:PAtld e'4 S
<br />S
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<br />BRELLA LIAR OCCUR FAGH Or:.CI)RRFNfF 5 10,000,000
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<br />CESSLIAB MAOE CU209B2430201 0813112018 06/3112019 AGGftEwrE 5 10,000,000
<br />O TArm 9Ymv* rw .....,..,... - .w.�.�.� �...w. ... EACH AT.
<br />ERS COMPENSATION
<br />ly
<br />�Y- w YNN NIA WC209824402 08131/2018 06/3112019 a H_ 500000
<br />�RHMPLOYER6 LIABILITY ECTIVE tl E ACCIDENT
<br />FH..... S
<br />AND E
<br />AX1, t'81�1C1P 141E YG In it ,iLRL
<br />Mande roAr p O'..YAi,:9. JO1 ' U E A DIPEA, ^
<br />( nY n N 9E-FAPMPtOYFE S 500,000
<br />If yes, desrnbe under '., r600 000
<br />DESCRIPTIONOFOPERATIONSbelmv EL DISEASE -POLICY LIMIT S
<br />I —]Each Occurance, $13,000,000
<br />Excess Umbrella
<br />B ZUP11ROD85017NF 08J3112018 06/31/2019 'Aggregate $13,000.000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Addi lonal Remarks Schedule, may be attached I more apace Is required)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />FOR PROOF OF COVERAGE ONLY PLEASE REQUEST SPECIFIC ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />® 1988-2016 ACORD CORPORATION. All rights reserved.
<br />ACOf l) 25 (2016103) The ACORD name and logo are registered marks of ACORD
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