Opening of Bids - Fire Station No. 8 Replacement Proj No. 122-034 - R. Yoder Construction Inc.

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Client#: 180877 RYODCON ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)10/21/2022 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER EPIC Insurance Midwest 609 W. Lincoln Avenue Goshen, IN 46526 NAME: Sally Miller PHONE 574-537-1463 FAX A/C, No, Ext : A/C, No): E-MAIL ADDRESS: sally p• miller a Icbrokers.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Selective Insurance Company of America 12572 INSURED R. Yoder Construction, Inc. PO Box 69 INSURER B : INSURER C Nappanee, IN 46550 INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X S2549081 10/19/2022 10119/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE � OCCUR PREMISES ERENTED ccr nce $ 300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 R- POLICYFI JECT LOC PRODUCTS - COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY S2549081 10/19/2022 10/19/202 a.cid.n SINGLE LIMIT Ea MINED $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY A X UMBRELLA LIAB X OCCUR S2549081 10/19/2022 10/19/2023 EACH OCCURRENCE s5,000,000 AGGREGATE s5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? FW N / A X WC9104781 10/19/2022 10119/2023 X STATUTE EORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is Included as Additional Insured under the Automobile Policy when required under written contract or agreement. Certificate Holder is Included as Additional Insured under the General Liability Policy when required under written contract or agreement. (See Attached Descriptions) R Yoder Construction Inc PO Box 69 Nappanee, IN 46550 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 1 of 2 #S4344663/M4344602 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SM102