HomeMy Public PortalAbout141-2017 - Perseponko Painting - Painting Stairwells in LabAGREEMENT @k1@1kh
THIS AGREEMENT made and entered into this day of October, 2017, by and between the
City of Richmond, Indiana, a municipal corporation acting by and through its Board of Sanitary
Commissioners (referred to as the "City"), and Perseponko Painting L.L.C., 3559 Boston
Township Line Road, Richmond, Indiana 47374 (hereinafter referred to as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains Contractor for painting of laboratory building bay walls, stairwells and steel
piping in the Whitewater Waste Treatment Plant, 2380 Liberty Avenue, Richmond, Indiana.
A Request for Quotes has been made available for inspection by City, is on file in the office of
the Department of Sanitation for the City of Richmond, consisting of four (4) typewritten pages,
which is attached hereto and incorporated by reference herein as Exhibit "A".
The response of Contractor to said Request for Quotes is attached hereto and incorporated by
reference herein as Exhibit `B", consisting of two (2) typewritten page.
Should any provisions, terms, or conditions contained in any of the documents attached hereto
and incorporated by reference herein as Exhibits, conflict with any of the provisions, terms, or
conditions of this Agreement, this Agreement shall be controlling.
The Contractor shall furnish all labor, material, equipment, and services necessary for the proper
completion of all work specified. Contractor shall submit statements or bills monthly.
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of insurance and/or warranties;
2. The City is in receipt of any required affidavit(s) signed by Contractor in accordance with
I.C. § 22-5-1.7-11(a)(2); and
3. A purchase order has been issued by the Purchasing Department.
SECTION II. STATUS OF CONTRACTOR
Contractor shall be deemed to be an independent contractor and is not an employee or agent of
the City of Richmond. The Contractor shall provide, at its own expense, competent supervision
of the work.
SECTION III. COMPENSATION
City shall pay Contractor at the rates indicated in Exhibit `B" in an amount not to exceed
Fourteen Thousand Two Hundred Sixty -Four Dollars and No Cents ($14,264.00), for complete
and satisfactory performance of the work required hereunder. The monies to be paid to
Contractor are based upon the Proposal Sheet of and submitted by Contractor, which is set forth
in Exhibit "B", and attached with this Agreement and made a part hereof.
Contract No.141-2017
1 I Pace
SECTION W. TERM OF AGREEMENT
This Agreement shall become effective immediately upon signing of this Agreement and shall
continue in effect until in effect to and including December 31, 2017.
Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in
part, for cause, at any time by giving at least thirty (30) days written notice specifying the
effective date and the reasons for termination which shall include but not be limited to the
following:
a. failure, for any reason of the Contractor to fulfill in a timely manner
its obligations under this Agreement;
b. submission of a report, other work product, or advice, whether oral or written, by the
Contractor to the City that is incorrect, incomplete, or does not meet reasonable
professional standards in any material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant funding to the City under which this Agreement
is made; or
e. unavailability of sufficient funds to make payment on this Agreement.
This Agreement may also be terminated by either the City or the Contractor, in whole or in part,
by mutual Agreement setting forth the reasons for such termination, the effective date, and in the
case of partial termination, the portion to be terminated.
This Agreement may also be terminated by either the City or the Contractor, without cause, by
giving at least thirty (30) days written notice to the other party.
In the event of termination of this Agreement, the City shall be required to make payment for all
work performed prior to the date this Agreement is terminated, but shall be relieved of any other
responsibility herein.
SECTION V. INDEMNIFICATION AND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to
person or property or any other claims which may arise from the Contractor's conduct or
performance of this Agreement, either intentionally or negligently; provided, however, that
nothing contained in this Agreement shall be construed as rendering the Contractor liable for acts
of the City, its officers, agents, or employees. Contractor shall as a prerequisite to this
Agreement, purchase and thereafter maintain such insurance as will protect it from the claims set
forth below which may arise out of or result from the Contractor's operations under this
Agreement, whether such operations by the Contractor or by any sub -contractors or by anyone
directly or indirectly employed by any of them, or by anyone for whose acts the Contractor may
be held responsible.
2 1 °ac(e
Coverage Limits
A. Worker's Compensation & Statutory
Disability Requirements
B. Employer's Liability $100,000
C. Comprehensive General Liability
Section 1. Bodily Injury $1,000,000 each occurrence
$2,000,000 aggregate
Section 2. Property Damage $1,000,000 each occurrence
D. Comprehensive Auto Liability
Section 1. Bodily Injury $1,000,000 each person
$1,000,000 each occurrence
Section 2. Property Damage $1,000,000 each occurrence
E. Comprehensive Umbrella Liability $1,000,000 each occurrence
$1,000,000 aggregate
F. Malpractice/Errors & Omissions Insurance $1,000,000 each occurrence
$2,000,000 aggregate
SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board showing that the Contractor has complied with Indiana Code
Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore
subject to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its home state's worker's compensation law and provide the City proof of such
compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law.
SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM
REQUIREMENTS
Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work
eligibility status of all newly hired employees of the contractor through the Indiana E-Verify
program. Contractor is not required to verify the work eligibility status of all newly hired
employees of the contractor through the Indiana E-Verify program if the Indiana E-Verify
program no longer exists. Prior to the performance of this Agreement, Contractor shall
provide to the City its signed Affidavit affirming that Contractor does not knowingly employ
an unauthorized alien in accordance with IC 22-5-1.7-11 (a) (2). In the event. Contractor
violates IC 22-5-1.7 the Contractor shall be required to remedy the violation not later than
thirty (30) days after the City notifies the Contractor of the violation. If Contractor fails to
remedy the violation within the thirty (30) day period provided above, the City shall consider
the Contractor to be in breach of this Agreement and this Agreement will be terminated. If
the City determines that terminating this Agreement would be detrimental to the public
3 1 Pain
interest or public property, the City may allow this Agreement to remain in effect until the
City procures a new contractor. If this Agreement is terminated under this section, then
pursuant to IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual
damages.
SECTION VIII. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not
engaged in investment activities in Iran. In the event Board determines during the course
of this Agreement that this certification is no longer valid, Board shall notify Contractor
in writing of said determination and shall give contractor ninety (90) days within which
to respond to the written notice. In the event Contractor fails to demonstrate to the Board
that the Contractor has ceased investment activities in Iran within ninety (90) days after
the written notice is given to the Contractor, the Board may proceed with any remedies it
may have pursuant to IC 5-22-16.5. In the event the Board determines during the course
of this Agreement that this certification is no longer valid and said determination is not
refuted by Contractor in the manner set forth in IC 5-22-16.5, the Board reserves the right
to consider the Contractor to be in breach of this Agreement and terminate the agreement
upon the expiration of the ninety (90) day period set forth above.
SECTION IX. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting
on behalf of Contractor or any sub -contractor shall not discriminate against any employee
or applicant for employment to be employed in the performance of this Agreement, with
respect to hire, tenure, terms, conditions or privileges of employment or any matter
directly or indirectly related to employment, because of race, religion, color, sex,
disability, national origin, or ancestry.
B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees:
1. That in the hiring of employees for the performance of work under this
Agreement of any subcontract hereunder, Contractor, any subcontractor, or any
person acting on behalf of Contractor or any sub -contractor, shall not
discriminate by reason of race, religion, color, sex, national origin or ancestry
against any citizen of the State of Indiana who is qualified and available to
perform the work to which the employment relates;
2. That Contractor, any sub -contractor, or any person action on behalf of Contractor
or any sub -contractor shall in no manner discriminate against or intimidate any
employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
3. That there may be deducted from the amount payable to Contractor by the City
under this Agreement, a penalty of five dollars ($5.00) for each person for each
calendar day during which such person was discriminated against or intimidated
in violation of the provisions of the Agreement; and
4. That this Agreement may be canceled or terminated by the City and all money
due or to become due hereunder may be forfeited, for a second or any subsequent
violation of the terms or conditions of this section of the Agreement.
. ........ _.___.... .
__ _ 4 1 Prue
C. Violation of the terms or conditions of this Agreement relating to discrimination or
intimidation shall be considered a material breach of this Agreement.
SECTION X. RELEASE OF LIABILITY
Contractor hereby agrees to release and hold harmless the City and all officers, employees, or
agents of the same from all liability which may arise in the course of Contractor's performance of
its obligations pursuant to this Agreement.
SECTION XI. MISCELLANEOUS
This Agreement is personal to the parties hereto and neither party may assign or delegate any of
its rights or obligations hereunder without the prior written consent of the other party. Any such
delegation or assignment, without the prior written consent of the other party, shall be null and
void. This Agreement shall be controlled by and interpreted according to Indiana law and shall
be binding upon the parties, their successors and assigns. This document constitutes the entire
Agreement between the parties, although it may be altered or amended in whole or in part at any
time by filing with the Agreement a written instrument setting forth such changes signed by both
parties. By executing this Agreement the parties agree that this document supersedes any
previous discussion, negotiation, or conversation relating to the subject matter contained herein.
This Agreement may be simultaneously executed in several counterparts, each of which shall be
an original and all of which shall constitute but one and the same instrument.
The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit
arising out of this Contract must be filed in said courts. The parties specifically agree that no
arbitration or mediation shall be required prior to the commencement of legal proceedings in said
Courts. By executing this Agreement, Contractor is estopped from bringing suit or any other
action in any alternative forum, venue, or in front of any other tribunal, court, or administrative
body other than the Circuit or Superior Courts of Wayne County, Indiana, regardless of any right
Contractor may have to bring such suit in front of other tribunals or in other venues.
Any person executing this Contract in a representative capacity hereby warrants that he/she has
been duly authorized by his or her principal to execute this Contract.
In the event of any breach of this Agreement by Contractor, and in addition to any other damages
or remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this
Agreement, including but not limited to, City's reasonable attorney's fees.
In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption
or burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any
of the provisions of this Agreement.
5 1 ?age
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of
the day and year first written above, although signatures may be affixed on different dates.
"CITY"
The City of Richmond, Indiana, by and through
its Board o Sanitary Commissioners
due Miller, President
"CONTRACTOR"
Perseponko Painting L.L.C.
By:
(Printed): Michael Perseponko
ice President Title: President
Dated:
Member
Dated: 6 .2' 7
APPROVED:
ave now, Ma;
Dated: / G -2 � - 1
6 1 ?aae
PRICE REQUEST
OF X
A{ O
u o
A
CITY OF MCHMO"
DEPARTMENT OF SANITATION
2380 LIBERTY AVENUE.RICHMOND, INDIANA 47374
PHONE (765) 983-7450.FAX (765) 962-2669
r.>
THIS IS NOT AN ORDER
VENDOR
INSTRUCTIONS
This is a request for a price for the services of materials
described below. Any additional specifications may be
attached hereto. This is NOT an order and the City reserves
the right to accept all or part, or decline the entire proposal.
Please complete your full name and phone number below
with signature; itemize all prices and charges where
requested; and attach any explanation for any substitution to
specifications altered. Return in a sealed envelope, in care of
Richmond Sanitary District Board of Commissioners to
the administration building at the address above by the
specified date and time to be considered.
DATE:
REPLY MUST BE IN BY:
PAYMENT TERMS:
DELIVERY REQUIRED:
August 31, 2017 .
September 26, 2017 by 10:OOAM
UPON RECEIPT OF INVOICE
DELIVERED
DESCRIPTION
This is a request for quotes for painting. Please see attached specifications. All E-Verify requirements will
apply to this quote. Please include a Certificate of Insurance, which must include Worker's Compensation,
and Warranty Information with quote.
Return the quote in a sealed envelope addressed to:
Richmond Sanitary District
Denise Johnson, Customer Svc Mgr
2380 Liberty Avenue
Richmond, IN 47374
Re: Painting
If you have any questions please call Jeff Lohmoeller at 765-983-7464 or 765-993-2670.
Pre -Quote meeting will be held, on September 8th at 9:OOAM,
Richmond Sanitary District Board Room, 2380 Liberty
Avenue, Richmond, Indiana.
Total Cost:
Time of Completion:.1.c',A 4,� Days
Quote Valid Until:
STATE TAX EXEMPTION # 003121909-001
Richmond Sanitary District
ivruvlc yr rimm wuv I uv�.
AUTHORqX6 BY SIGNATURE
TITLE
DATE PHONE NUMBER
PRE -QUOTE MEETING AGENDA
RICHMOND SANITARY DISTRICT
Painting of Bay Walls, Stairwells, Steel Piping at IPB and Steel Cabinets in Lab
Date: September 08, 2017
Time: 09:00am
Location: Administration Building
2380 Liberty Avenue
Richmond, IN 47374
1. Introduction and Sign -In Sheet
2. Go over request and specs
a. E-Verify Requirements
b. Local Preference Claims
c. Certificate of Insurance
d. Iran Investment Activities
e. Start Date once Contract and PO is issued
f. Length of Project
3. Quotes will be due back— September 26 by 10:00am
4. Open Discussion
5. Site Tour
6. Adjourn
/D, zoE07
Painting of Building Bay Walls, Stairwells, Steel Piping in WWTP
The Richmond Sanitary District will be requesting quotes for Laboratory Building
steel cabinets, Intermediate Pump Building bay walls, stairwells and outdoor steel
piping all to be prepped, primed and painted at the Wastewater Treatment Plant.
This work will be done Monday through Friday between 7:30 am to 4:00 pm
unless other arrangements are made by contractor.
Certificate of Insurance required at the time of quote opening.
Notice to Contractor: E-Verifying requirements along with Indiana Local
Preference Claim Information.
• A pre -quote meeting will be held on September 8th @ 9:00am in
Administration Board Room, 2380 Liberty Avenue, Richmond, IN 47374
CC HFr)t II F
SCOPE OF WORK:
Attachments
Interior Finishes
Concrete/Cement
Primer: B79W08810 - ProBlock® Interior Oil -Based Primer White
Finish: K45W00151- Pro Industrial PreCatalyzed Waterbased Epoxy Eg-Shel Extra
White
Color to match existing in IPB Bay and stairway
Steel Cabinets in Lab Area
Primer: B50WZ0004 - Kern Bond' HS High Solids Alkyd Universal Metal Primer Off
White Off White
Finish: B54W00151- Pro Industrial Urethane Alkyd Enamel Extra White
Exterior Finishes
Steel Rail Piping — East and West side of IBP 2"d floor.
Primer: B50WZ0004 - Kem Bond° HS High Solids Alkyd Universal Metal Primer Off
White Off White
Finish: B54W00151- Pro Industrial Urethane Alkyd Enamel Extra White
color to match existing or possibly change!
Z:A)b
SURFACE PREPARATION
1) Previously Coated Surfaces
Maintenance painting will frequently not permit or require complete removal of
all old coatings prior to repainting. However, all surface contamination such as oil,
grease, loose paint, mill scale, dirt; foreign matter, rust, mold, mildew, mortar,
efflorescence, and sealers must be removed to assure sound bonding to the
tightly adhering old paint. Glossy surfaces of old paint films must be clean and dull
before repainting. Thorough washing with an abrasive cleanser will clean and dull
in one operation, or, wash thoroughly and dull by sanding. Spot prime any bare
areas with an appropriate primer. Recognize that any surface preparation short of
total removal of the old coating may compromise the service length of the
system. Check for compatibility by applying a test patch of the recommended
coating system, covering at least 2 to 3 square feet. Allow to dry one week before
testing adhesion per ASTM D3359. If the coating system is incompatible, complete
removal is required.
2) Hand Tool Cleaning
Hand Tool. Cleaning removes all loose mill scale, loose rust, and other detrimental
foreign matter. It is not intended that adherent mill scale, rust, and paint be
removed by this process. Mill scale, rust, and paint are considered adherent if
they cannot be removed by lifting with a dull putty knife. Before hand tool.
cleaning, remove visible oil, grease, soluble residues, and salts by the methods
outlined in SSPCSPI. For complete instructions, refer to Steel Structures Paint
Council Surface Preparation Specification No. 2 (SSPC-SP2)
3) Power Tool Cleaning
Power Tool Cleaning removes all loose mill scale, loose rust, and other
detrimental foreign matter. It is not intended that adherent mill scale, rust, and
paint be removed by this process. Mill scale, rust, and paint are considered
adherent if they cannot be removed by lifting with a dull putty knife. Before
power tool cleaning, remove visible oil, grease, soluble residues, and salts by the
methods outlined in SSPCSPI. For complete instructions, refer to Steel Structures
Paint Council Surface Preparation Specification No.3.(SSP-PC3)
4) Commercial Blast Cleaning
4-7
A Commercial Blast Cleaned surface, when viewed without magnification, shall be
free of all visible oil, grease, dirt, dust, mill scale, rust, paint, oxides, corrosion
products, and other foreign matter, except for staining. Staining shall be limited
to no more than 33 percent of each square inch of surface area and may consist
of light shadows, slight streaks, or minor discoloration caused by stains of rust,
stains of mill scale, or stains of previously applied paint. Before blast cleaning,
visible deposits of oil or grease shall be removed by any of the methods specified
in SSPC-SP1 or other agreed upon methods. For complete instructions, refer to
Joint Surface Preparation Standard (SSPC-SP6/NACE No. 3)
5) Water Blasting NACE Standard RP-01-72
Removal of oil grease dirt, loose rust, loose mill scale, and loose paint by water at
pressures of 2,000 to 2,500 psi at a flow of 4 to 14 gallons per minute.
Painting of Building Bay Walls, Stairwells, Steel Piping in WWTP
Proposal Sheet
NAME OF CONTRACTOR:
ADDRESS.t1W 6,5 0A1T0 U&f/P /MM115- 666
CITY/STATE: jelMIi AA(,d &Z J�7j-7s�
Intermediate Pump Building Bay and Stairwell: $ we a - eC�
Steel Cabinets in Lab Area: $ 'Mee - 6).6
Steel Rail Piping — East and West side of IBP 2"d floor: $ Al- 6 G
• CERTIFICATE OF INSURANCE INCLUDED (must meet the City of Richmond, IN requirements)
YES NO
• E-VERIFICATION FORM FILLED OUT:
• LOCAL PREFERENCE CLAIM:
• IRAN INVESTMENT ACTIVITIES
YES V/ NO
YES NO
YES NO V
PRICE REQUEST
04 A
+{ O
Z
4 O
�t II
�h
1
CITY OF RICIMOND
DUARTIVIENT OF SANITATION
2380 LIBERTY AVENUE.RICHMOND, INDANA 47374
PHONE (765) 983-7450.FAX (765) 962-2669
THIS IS NOT AN ORDER
VENDOR
INSTRUCTIONS
This is a request for a price for the services_ of materials
described below. Any additional specifications may be
PerSep011k0 Palming LLC
attached hereto. This is NOT an order and the City reserves
the right to accept all or part, or decline the entire proposal.
3559 Boston Township Line Road
Please complete your full name and phone number below
with signature; itemize all prices and charges where
Richmond, IN 47374
requested; and attach any explanation for any substitution to
specifications altered. Return in a sealed envelope, in care of
Richmond Sanitary District Board of Commissioners to
the administration building at the address above by the
specified date and time to be considered.
DATE:
REPLY MUST BE IN BY:
PAYMENT TERMS:
DELIVERY REQUIRED:
August 30, 2017
September 26, 2017 by I O:OOAM
UPON RECEIPT OF INVOICE
DELIVERED
DESCRIPTION
This is a request for quotes for painting. Please see attached specifications. All E-Verify requirements will
apply to this quote. Please include a Certificate of Insurance, which must include Worker's Compensation,
and Warranty Information with quote.
Return the quote in a sealed envelope addressed to:
Richmond Sanitary District
Denise Johnson, Customer Svc Mgr
2380 Liberty Avenue
Richmond, IN 47374
Re: Painting
If you have any questions please call Jeff Lohmoeller at 765-983-7464 or 765-993-2670.
Pre -Quote meeting will be held on September 8th at 9:OOAM, Richmond Sanitary District Board Room, 2380 Liberty
Avenue, Richmond, Indiana. C J
-�-�-��4/ 2-6 7 �
Total Cost:
Time of Completion: 2 2 Days
Quote Valid Until:
STATE TAX EXEMPTION # 003121909-001
Richmond Sa i ary District
i4mivir_ ur rimm wuu I irv,_u.,
Riasc)e
f ?
AUTbO&ZED BY SIGNATURE
TITLE
lee - 61-4-
DATE PHONE NUMBER
�E
A l ewe 1Y le -J -,
Painting of Building Bay Walls, Stairwells, Steel Piping in WWTP
Proposal Sheet
NAME OF CONTRACTOR: -�-,256Potr-yL0- RAi'm 11N& LL L
ADDRESS: JS6%
CITY/STATE: 921 U4 ,770AJ
Intermediate Pump Building Bay and Stairwell: $ `19d6 • OC,
Steel Cabinets in Lab Area: .56 [7 0 v
Steel Rail Piping— East and West side of IBP 2"d floor: $ / 94 V . D U
• CERTIFICATE OF INSURANCE INCLUDED (must meet the City of Richmond, IN requirements)
YES_NO
• E-VERIFICATION FORM FILLED OUT: YES 1/ NO,
• LOCAL PREFERENCE CLAIM: YES V NO
• IRAN INVESTMENT ACTIVITIES, YES NO V
J\A/uJAY �-
•�,1
,�i.i INDIANA FARM
BUREAU INSURANCE'
NAMED INSURED AND ADDRESS:
PERSEPONKO PAINTING LLC
3559 BOSTON TOWNSHIP LINE RD
RICHMOND IN 47374
CERTIFICATE OF INSURANCE
CERTIFICATE ISSUED TO:
DEPARTMENT OF SANITATION
2380 LIBERTY AVENUE
RICHMOND IN 47374
This is to certify that the policies listed in this Certificate have been issued to the Named Insured by
MA UFB CASUALTY INSURANCE COMPANY ® UNITED FARM FAMILY MUTUAL INSURANCE COMPANY
The policies of insurance fisted on this certificate 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 is subject to all terms, exclusions and conditions of such policies. Aggregate limits shown may have been reduced by paid claims. This
Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does
it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
Type of Insurance
Policy Number
Company
Effective
Date
Expiration
D
Limits of Liability
COMMERCIAL LIABILITY
BOP8213669 02
B
0212012017
02/20/2018
General Aggregate
$2,000,000
[ X ] Commercial General Liability
Prod.-Comp/OPS Aggregate
$2,000,000
[ X) Occurrence
Personal -Advertising Injury
$1,000,000
Each Occurrence
$1.000.000
Fire Damage (Any one fire)
$50,000
Med Ex se (Any one n)
$5,000
FARM LIABILITY
Each Occurrence
[ ] Equine
Med Expense (Any one person)
[ ] Occurrence
COMM. AUTO LIABILITY
CAP8502870 02
B
02/20/2017
02/2 18
Each Accident
$1,000,000
[ X ] Scheduled Autos
Med Expense
$5,000
[ X ] Hired Autos
[ X ] Non -Owned Autos
FARM AUTO LIABILITY
Each Accident
[ } Scheduled Autos
Med Expense
[ ] Hired Autos
[ ] Non -Owned Autos
UMBRELLA LIABILITY
UMBBW3624 02
B
02/20/2017
02/20/2018
Each Occurrence
Aggregate
$5,000,000
WORKERS'
WC 83M210 02
B
02/20/2017
02120/2018
Statutory - Indiana
COMPENSATION
$1,000,000
Each Accident
AND
Disease Policy Limit
$1.000,000
EMPLOYERS'LIABILITY
Disease Each Employee
$1.000,000
OTHER
nVQVD1VT1nN nV nPVRATIOWtti
LOCATIONS VFHICLM
RESTRICTIONS.
AND
SPECIAL ITEMS
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).
Should any of the described policies be canceled before the expiration date, the issuing insurer will make an effort to notify the certificate holder named, but
failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
GREGIBUTLER
Agent
09AW2017
Date
765-962-9548
Phone
06-996 3-12 [ J Certificate Holder's Copy [ ] Home OifceCopy [ ] Agency Copy [ J Insureft Copy Page I of 1
Printed: 09/05/2017 09:39:31 AM