93-290 Resolution No. 93-290
RESOLUTION
AUTHORIZING EXECUTION OF AN ACCESS AGREEMENT
'Pul
(458 Dundee Avenue) `
("}s> t„L- a-• f
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,
ILLINOIS, that George VanDeVoorde, Mayor, and Dolonna Mecum,
City Clerk, be and are hereby authorized and directed to
execute an Access Agreement on behalf of the City of Elgin
with Handex of Illinois, Inc. , a copy of which is attached
hereto and made a part hereof by reference.
s/ George VanDeVoorde
George VanDeVoorde, Mayor
Presented: November 17, 1993
Adopted: November 17, 1993
Vote: Yeas 7 Nays 0
Attest:
s/ Dolonna Mecum
Dolonna Mecum, City Clerk
- El •
Agenda Item No.
October 26, 1993
TO: Mayor and Members of the City Council
FROM: Robert 0. Malm, Interim City Manager
SUBJECT: Authorization of an Access Request to Drill
Monitoring Wells at 458 Dundee Avenue
PURPOSE
The purpose of this memorandum is to authorize the City
Manager to sign an agreement with Handex of Illinois, Inc. to
permit the placement of one ( 1) groundwater monitoring well on
property owned by the City of Elgin at 458 Dundee Avenue.
BACKGROUND
Handex of Illinois, Inc. has been retained by the Amoco
Oil Company to conduct a subsurface investigation at 470
Dundee Avenue (John's Amoco) . Last winter Handex installed
two monitoring wells at 458 Dundee Avenue. The two wells were
installed approximately 25 feet south of the Amoco property
line.
Under the terms of this agreement, Handex will provide
the results of tests to the City.
The access agreement has been reviewed by the City' s
Legal Department and all issues raised by the City have been
addressed to the City' s satisfaction by Handex of Illinois,
Inc.
FINANCIAL IMPACT
None.
Mayor and Members of the City Council
October 26, 1993
Page 2
RECOMMENDATIONS
Authorize the City Manager to enter into the access
agreement with Handex of Illinois, Inc.
'10.-OA'o "�
1",k.W.ANEENNOM
Rob t 0. alm, Interim City Manager
ROM:RHM:daw
r
• 'r
ACCESS AGREEMENT FOR THE USE AND RIGHT
OF ENTRY ONTO PROPERTY
LOCATED AT
458 Dundee Avenue, Elgin, Illinois
THIS AGREEMENT, made by and between:
CITY OF ELGIN
Located at 150 Dexter Court in the Cit of Elgin , County of Kane and State of
Illinois as set forth on the official tax map of the City- of Elgin , hereinafter referred to
and known as "Owner";
HANDEX OF ILLINOIS, INC.
Located at 1701 West Quincy, Suite 31, township of Naperville, County of DuPage and
State of Illinois hereinafter referred to and known as "Handex", and;
WITNESSETH:
Handex, on behalf of Amoco Oil Company, either itself, its employees or agents,
or through its contractor, is about to undertake the installation, construction and
maintenance of a groundwater monitoring system, including monitoring wells on or about
the property owned by the Owner and located as shown in the site plan hereinafter
described in Schedule A attached hereto; and
The Owner, being the property owner or tenant, as the case may be, has agreed
to permit Handex, its employees, agents and contractors, the right to enter upon its
property located as stated above for the purpose of installing, constructing, maintaining,
monitoring and sampling One 1 groundwater monitoring well(s) as may be approved
and authorized by the Illinois Environmental Protection Agency.
NOW THEREFORE, the Owner and Handex agree as follows:
1. Handex and its employees, agents, and contractors, shall be permitted to
enter upon the Owner's property as stated above for the purpose as
aforesaid.
1
0'-jand=
2. The rights and privileges granted by this instrument to Handex, its
employees, agents, and contractors, for the use of the above described
property depicted in the site plan in Schedule A attached hereto, shall cease
and terminate following completion of said activities as determined by
applicable government agencies and Handex or on December 31, 1993,
whichever occurs first.
3. Handex, its employees, agents and contractors agree that they shall: a)
maintain the property used throughout the aforesaid period; b) not
traverse on any other portion of the lands owned by the Owner, not subject
to the agreement, other than those contained in the within right of entry
agreement herein described; c) perform the work in a workmanlike
manner; and d) maintain the well, well cover and appurtenances in good
condition and repair, in accordance with appropriate municipal codes; and
e) submit a site health and safety plan.
4. Handex, its employees, agents and contractors, further agree that the
property of the Owner, which is utilized in this agreement, during the
construction of any work described above, or during any other time of this
agreement, which is damaged during the use and term of this agreement,
shall be restored as nearly as may be reasonably possible to its original
condition as prior to entry as soon as practicable.
5. Handex, its employees, agents and contractors, shall maintain combined
single limit insurance of at least $1,000,000.00 including contractual liability
coverage for independent contractors, and explosion, collapse and
underground coverage, and will provide Owner with a certificate of
insurance for the above, naming the Owner as co-insured, and will obtain
written permission from the Owner's Public Works Director before drilling
begins.
6. Handex shall forever indemnify, defend, and hcid City of Elgin officers and
directors harmless from and against any and all claims, losses, liabilities,
demands, costs, and expenses, including reasonable attorney's fees, arising
out of or in connection with the project and testing performed by Handex
and for any claims, losses, liabilities, demands, costs, and expenses, arising
out of or in connection with the ownership of any of the substances located
during the testing procedure. All indemnification, defense, and hold
harmless obligations of Handex shall survive the terms of this agreement.
7. Any hazardous or toxic substances, hazardous or toxic waste, pollutants or
contaminants, or other waste materials encountered by or associated with
the test performed by Handex shall at no time become the property of the
Owner.
2
8. The Owner shall be provided with the results of prior testing conducted on
City of Elgin property, under the Access Agreement executed on November
11, 1992, and the results of any testing conducted on the well covered
under this agreement.
IN WITNESS, the Owner and Handex have signed and sealed this Agreement on
the dates set forth below.
WITNESS:
- ;.� ��. �
BY: �� ��� E:
i
Owner'
WITNESS: HANDEX OF ILLINOIS, INC.
BY: , DATE: I /2,2-/9's
Roger E. Well, Site Manager
3
SUMMIT STREET
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CATCH BASIN
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- FIGURE 1
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WATER LINE SITE PLAN
AMOCO SERVICE STATION
$
mw-9 ® # 19564
Fi0 UST p MEASE Try mw-8 470 DUNDEE RD.
ELGIN. ILL.
BETHESDA CHURCH OF CHRIST WATER BUFFALO BOX
HANDEX OF ILLINOIS, INC.
SITE HEALTH AND SAFETY PLAN
SITE NAME: Amoco Service Station No 19564
ADDRESS 470 Dundee Avenue
CITY/STATE Elgin Illinois 60120
INDICATING Dundee Avenue & Summit Street
CROSS STREETS
AND COUNTY Kane County
HANDEX LOCATION CODE: 105536
CLIENT LOCATION CODE: 19564
ORIGINAL PLAN DATE: Sept.22. 1993
ENTRY DATE: Oct.. 1993
DRILLING
MONITORING
SAMPLING
REVISED PLAN DATE: REVISED PLAN DATE:
PLAN PREPARATION:
PREPARED BY: Douglas P. Klicman DATE:Aug. 31. 120
REVIEWED BY: (Please print your name under your signature.)
4
HYDROGEOLOGIST: C—DATE:
Michael P.Hays
PROJECT MANAGER: DATE: 9-22,93
P.b
APPROVALS: Atj�
FI ELD SAFETY COORDINATOR: TE: —2z—
P.Hoyt
PRICIPAL HYDROGEOLOGIST: /(i✓ DATE: 1 3
well
HASP - AMOCO No. 19564 1
SITE NAME: Amoco Service Station No 19564
ADDRESS 470 Dundee Avenue
CITY/STATE Elgin Illinois 60120
INDICATING Dundee Avenue & Summit Street
CROSS STREETS
AND COUNTY Kane County
EMERGENCY PHONE NUMBERS
BUSINESS TELEPHONE: (708) 527-1666 (Handex)
LOCAL POLICE: (708) 741-2131 911 Emergency
LOCAL FIRE: (708) 741-2121 911 Emergency
LOCAL RESCUE: (708) 741-2121 911 Emergency
LOCAL HOSPITAL: (708) 742-9800
LOCAL HOSPITAL: Sherman Hospital
934 Center Street: Elgin IL
ROUTE FROM SITE: (see attached maps
West on Summit Street to Spring Street: North on Spring Street. Hospital is
located on the North side of the road.
KEY PERSONNEL: OFFICE RESOURCES
Handex of Illinois Business (708) 527-1666
1701 W. Quincy Ave., Suite 31
Naperville, IL 60540
Roger Well (Site Manager) Office (708) 527-1666
Portable (708) 217-4266
Doug 10cman (Project Manager) Office (708) 527-1666
EMERGENCY CONTACTS: MEDICAL & HEALTH
City of Elgin police Non-emergency (708) 741-2131
City of Elgin fire department Non-emergency (708) 741-2121
Emergency 911
HASP - AMOCO No. 19564 2
SITE MAP
Provide three maps, (MAP 1, MAP 2, & MAP 3), that show the following information:
A TOPOGRAPHIC MAP IS NOT ACCEPTABLE
USE AN EXISTING SITE MAP OR NEATLY HAND SKETCH A SITE MAP THAT
SHOWS THE LOCATION OF THE FOLLOWING:
MAP 1 - LOCAL ROAD MAP, indicating the site and adjacent roads,
MAP 2 - SITE MAP, indicating the site's main features, such as, gasoline
station repair building, pump Islands, well locations,
aboveground and/or underground storage tanks, etc.
MAP 3 - ROUTE TO HOSPITAL
COMMENTS:
HASP - AMOCO No. 19564 3
A. SITE DESCRIPTION: One story building: three service bays: five dispensers:
three 10,000 gallon & one 550 gallon USTs
SITE HISTORY: Site has been a retail service station since 1983.
SUMMARY OF HAZARDS: traffic: overhead & buried utilities
AREA OF CONCERN: The southeast corner of the property and the off-site alley
adjacent to the property (south) and the church.
NEIGHBORHOOD DESCRIPTION: Light commercial
TOPOGRAPHY AND SITE ACCESS: Flat: access from Summit Street and
Dundee Avenue.
ADDITIONAL INFORMATION:
HASP - AMOCO No. 19564 4
B. PROJECT OBJECTIVES - THE OBJECTIVE OF THIS PROJECT IS TO:
(DESCRIBE TASK(S) TO BE PERFORMED, i.e., .DRILL, INSTALL MONITOR
WELLS, MONITOR/GAUGE WELLS, COLLECT SAMPLES,
INSTALLATION/MAINTENANCE OF RECOVERY SYSTEM, ETC.)
Installation of one recovery well ground water sampling and perform an aguifer
test.
PLANNED DRILLING METHOD: Hollow-stem auger
C. ON-SITE ORGANIZATION AND COORDINATION - THE FOLLOWING ARE
DESIGNATED TO CARRY OUT STATED JOB FUNCTIONS ON-SITE.
(NOTE: ONE PERSON MAY CARRY OUT MORE THAN ONE JOB FUNCTION.)
PROJECT MANAGER: Douglas P. Klicman
HYDROGEOLOGIST: Michael P. Hays
SITE SAFETY OFFICER:* Michael P. Hays
ALL ACTIVITIES ON-SITE MUST BE CLEARED BY THE HYDROGEOLOGIST.
* IN HIS/HER ABSENCE NEXT SENIOR HANDEX EMPLOYEE ON SITE.
D. ON-SITE CONTROL
A SAFE PERIMETER HAS BEEN ESTABLISHED WITH CONTROL
BOUNDARIES IDENTIFIED AND MARKED OFF WITH BOUNDARY TAPE,
TRAFFIC CONES, OR BARRICADES.
HASP - AMOCO No. 19564 5
E. 1. PHYSICAL HAZARDS
THE FOLLOWING PHYSICAL HAZARDS ARE EXPECTED ON-SITE:
overhead wires, utilities, substation power, mark out dates, slip, trip, and fall,
confined space, heavy traffic, etc.)
buried and overhead utilities, heavy traffic, mark outs will be called upon ROE
approval
FIRST-AID SUGGESTED FOR THE OBSERVED PHYSICAL HAZARD IS:
FOLLOW ESTABLISHED RED CROSS STANDARD FIRST-AID PROCEDURES
NOTED IN THE STANDARD FIRST-AID MANUAL.
2. PERSONAL PROTECTIVE EQUIPMENT:
BASED ON THE POSSIBILITY OF FUTURE CHANGES IN THE SCOPE OF
WORK OM THIS SITE, AND THE POTENTIAL FOR ADDITIONAL HAZARDS,
THE FOLLOWING LEVELS OF PROTECTION ARE ASSIGNED FOR WORK
AREAS OR TASKS LISTED:
JOB FUNCTION SITE LOCATION LEVEL OF PROTECTION DATE OF ENTRY
DRILLING CREW ENTIRE SITE A B C D OTHER
MONITORING TECH ENTIRE SITE A B C D OTHER
SAMPLING TECH ENTIRE SITE A B C D OTHER
INSTALLATION CREW ENTIRE SITE A B C D OTHER
MAINTENANCE TECH ENTIRE SITE A B C D OTHER
GAC MAINT-CARBON GAC SHED * A B C. D OTHER
DEWATERING CREW ENTIRE SITE A B C D OTHER
pH ADJ/INST. CREW GAC SHED A B C D OTHER
pH MAINT. TECH GAC SHED A B C D OTHER
RE-BED VAPOR/1-10 GAC SHED * A B C D OTHER
AIR STRIP INST CREW ENTIRE SITE A B C D OTHER
STRIP CLEAN/PACK ENTIRE SITE A B C D OTHER
TANK EXCAV CREW ENTIRE SITE A B C D OTHER
PUMP/SLUG TST TEAM ENTIRE SITE A B C D OTHER
SPECIFIC PROTECTIVE EQUIPMENT MODIFICATION FOR EACH LEVEL OF
PROTECTION IS AS FOLLOWS:
Steel toed boots, safety glasses, and hard hat
OTHER:
IF AIR PURIFYING RESPIRATORS ARE AUTHORIZED, ORGANIC VAPORS
(FILTERING MEDIUM) IS THE APPROPRIATE CANISTER FOR USE WITH THE
INVOLVED SUSTANCES AND CONCENTRATIONS.
* IN THE EVENT OF CARBON DUST SWITHCH TO LEVEL "C".
HASP - AMOCO No. 19564 6
F. HAZARD EVALUATION AND FIRST-AID
1.CHEMICAL HAZARDS AND AIR MONITORING SURVEY
THE FOLLOWING SUBSTANCES ARE KNOWN OR SUSPECTED TO BE ON-
SITE. THE PRIMARY HAZARDS OF EACH ARE IDENTIFIED. (Substance
concentrations are based on past lab analyses of soil or water samples.)
SUBSTANCES CONC�ITRATIONS PELjTEY' PRIMARY�tAZARDS- FIRST
(Chemtcalname) (if1cnovm) SYMPTaMSAND 1AIf
::.: >::::>;.:.::::::;:>;: : :::;:>::;::r::.;.:.. ...::;;::;:;:. ::;...EXPOSURE;SYST ;::.;.....................................
'::
.................... . . ::.:_:.;>;;;:.;;::._:.:.;::... .>.......::>. �9'Tox[c an Tra1►.Itationj >'
GASOLINE(TPHC) > 2000 ppm 200 ppm SKIN - INHALED E,A
in excavation Dermatitis, Eye irritant
BENZENE(SC) 1 ppm SKIN - INHALED E,A
Giddiness,Eye Irritant
TOLUENE 100 ppm SKIN - INHALED E,C
Dizziness,Fatigue
ETHYLBENZENE 100 ppm SKIN - INHALED A
Eye irritant
XYLENE 100 ppm SKIN - INHALED E,C
Dermatitis,Incoordination
' Permissible Exposure Limit(OSHA)or Threshold Limit(ACGIH)for time-weighted average for na li-hr work day
or 40-hr workweek.
FIRST-AID: (A) IRRIGATE IMMEDIATELY (B) WATER FLUSH IMMEDIATELY
(C) ARTIFICIAL RESPIRATION (D) MEDICAL ATTENTION IMMEDIATELY
(D) SOAP WASH IMMEDIATELY (F)
FIRST-AID EQUIPMENT AVAILABLE ON-SITE IS LOCATED:
FIRST-AID KIT - located in Handex vehicles
EMERGENCY EYE WASH - service station restroom sink
EMERGENCY SHOWER/HOSE - service station
THE SITE'S AIR MONITORING SURVEY REQUIRES USING THE FOLLOWING EQUIPMENT
(i.e. HNU, LEL or CGI, OXYGEN PERCENT, AND RADIATION METER)
THE RESULTS OF THE SITE'S AIR MONITORING SURVEY WHERE READINGS WERE
OBSERVED ABOVE BACKGROUND, ARE SHOWN ON THE ATTACHED SITE MAP AND ARE
DESCRIBED IN THE SPACE BELOW. MONITORING PROBES MEASURED THE AIR IN THE
BREATHING ZONE AND UPON OPENING MONITORING AND RECOVERY WELLS, SUMPS AND
SHEDS.
IF NO READINGS ABOVE BACKGROUND ARE OBSERVED, THE TERM 'NO HITS" IS NOTED IN
THE SPACE BELOW AND ON THE ATTACHED SITE MAP.
CIRCLE ONE OF THE FOLLOWING UNDERLINED CHOICES.
SITE AIR MONITORING SURVEY INDICATES READINGS AB_ OVE/AT BACKGROUND.
HASP - AMOCO No. 19564 7
f �y
A DESCRIPTION OF WHERE AIR MONITORING EQUIPMENT INDICATES A READING OVER THE
BACKGROUND, AND THE PROBE READING, IS AS FOLLOWS:
No Hits
G.1. DECONTAMINATION PROCEDURES
PERSONNELAND EQUIPMENT LEAVING AN IDENTIFIED EXCLUSION ZONE, (INDICATED
IN SECTION F), SHALL BE THOROUGHLY DECONTAMINATED. THE STANDARD LEVEL
"Cu DECONTAMINATION PROTOCAOL SHALL BE USED WITH THE FOLLOWING
DECONTAMINATION APPROACH: (1) WASH GLOVES & BOOTS USING DECON
SOLUTION AND TAP WATER RINSE; (2) REMOVE SECURING TAPE FROM WRISTS AND
ANKLES; (3) REMOVE DISPOSABL TYVEK (WITHOUT BOOTS); (4) REMOVE BOOT
COVERS & BOOTS; (5) REMOVE GLOVES; (6) REMOVE RESPIRATOR.
FOR LEVEL "D" DRESS-DOWN, FOLLOW STES 1, 3, 4, & 5.
2. ENVIRONMENTAL MONITORING
THE FOLLOWING MONITORING INSTRUMENTS SHALL BE USED AT SPECIFIED
INTERVALS.
O ITOR G:INS
.::.
11A N 11J TR11!IIIIE:N'X'. >: Sl?ECiF1ED INTERVC> >
::: >.;;;:>:::>::::: .
::<:......: :.:.;:::.:::;:.:.> >::::::::. .....:.:..:. CfJNTINU US HOURLY DAILY ETHER'.;;::.;;.
.. ................................::::::::.:..:.:::::::::::::::..:::::.:.::...........::.::.......::..........:::........................{.::..::...:::.... ... ............ ...: .:...::..::..::.::. .::.::...:......:. ..................::)......
OXYGEN MONITOR AS NEEDED
LEL INDICATOR AS NEEDED
HNU AS NEEDED
OVA AS NEEDED
CARBON MONOXIDE INDICATOR AS NEEDED
COLORIMETRIC TUBES (TYPE)
RADIATION DETECTOR
OTHER
HASP - AMOCO No. 19564 8
GUIDELINES FOR AIR MONITORING GASOLINE HAZARDS'
MONITORING HAZARD MEASURED LEVEL ACTION
CGI-COMBUSTIBLE GAS EXPLOSIVE < 10% LEL INVESTIGATE WITH
INDICATOR (% LOWER ATMOSPHERE IN CAUTION
EXPLOSIVE LIMIT OF IMMEDIATE WORK AREA
COMBUSTIBLE GASES)
> 10% LEL IXPOSION HAZARD
WITHDRAW FROM AREA
IMMEDIATELY
CGI- COMBUSTIBLE GAS OXYGEN < 19.5% MONITOR WHILE
INDICATOR (OXYGEN %) CONCENTRATION WEARING SCBA. N TE:
COMBUSTIBLE GAS
READINGS ARE NOT
VALID IN ATMOSPHERES
WITH < 19.5% OXYGEN
19.5 -23.5% CONTINUE
INVESTIGATION WITH
CAUTION
> 23.5% DISCONTINUE
INVESTIGATION
MONITORING. FIRE
HAZARD POTENTIAL
CONSULT SPECIALIST
PHOTO IONIZATION VOLATILE BREATHING ZONE LEVEL D PROTECTION
(HNU) / FLAME CONTAMINANTS BACKGROUND TO 200
IONIZATION (OVA) ppm
METERS
200 TO 300 ppm OVER LEVEL C PROTECTION
BACKGROUND
300 TO 500 ppm OVER LEVEL B PROTECTION
BACKGROUND
OVER 500 ppm OVER EVALUATE EXPOSURE
BACKGROUND SOURCE
' = GASOLINE IS USED FOR THIS GUIDELINE BASED ON IT'S HIGHER VOLATILITY.
= METER READINGS ARE NOT THE SOLE CRITERIA FOR SELECTING THE LEVEL OF PROTECTION.
THESE ARE ONLY GENERALIZED GUIDELINES.
ACTIONS TAKEN ARE BASED ON SUSTANED OR FREQUENT READINGS.
HASP - AMOCO No. 19564 9
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TELEPHONE LANE AMOC
1 10 20 40 u 19564
470 DUNDEE RD.
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SEE PAGES M20
.: :i.
_. : Y:: ;::iii:iiiii;iii:isri+'iii:.iyi!:iiiii:?7y;;i:,i:E);:2;:;. ... .. .. ..
xv : .. ,: : ........>;>::::;»::>::>::»::::?3i:#:i t"E i:::>?::::>:::>`::: r»::::: ISSUE DATE(MM/DDNY)
ACORD ERT F! A ` CAF � S R PI N: ::>::::::: :..::::;:>::::
1
09/ 4/93 m
a
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
Arthur J. Gallagher&Co.of N.Y.,Inc. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
465 Columbus Avenue,Suite 210 Companies Affording Coverage
Valhalla, New York 10595-1336 P 9 9
MIRANDA/SFERRAZZA Company A National Union
Letter
INSURED Letlterany B City Insurance Company
Handex of Illinois,Inc. Company
1701 W. Quincy Avenue,Suite 31 Letter C Home Insurance Company
Naperville,IL 60540 L me any D Travelers Insurance Company
Company E
Letter
COVERAGES
THIS IS TO CERTIFY THAT 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
A General Liability GLA5832307 02128/93 02/28/94* General Aggregate $ 5,000,000
❑x Commercial General Liability Products-complOPAgg. . $ 5,000,000
s [I Claims Made ❑Occurrence Personal 8 Adv.lnjury $ 5,000,000
Each Occurrence $ 5,000,000
❑Owners'&Contractors'Protective
❑Pollution(Sudden&Accidental) Fire Damage(Any one fire) S 100,000
❑X XCU Med Expense(Any one person) $ Included
B Automobile Liability BAF718082 02/28/93 02/28/94* Combined Single Limit $ 1,000,000
❑x Any Auto
❑All Owned Autos Bodily Injury(Per Person)
❑ $
Scheduled Autos
❑x Hired Autos Bodily Injury(Per Person) $
❑x Nonowned Autos
❑Garage Liability
❑ Property Damage s
C Excess Liability-Automobile CXLF598640 02/28/93 02/28/94* Each Occurrence $ 10,000,000
❑Umbrella Form Aggregate $ 10,000,000
❑x Other Than Umbrella Form
D Workers'Compensation 6K-UB-208K297-6-92 03/16/93 03/16/94 X Statutory Limits
And Each Accident f 100,000
Employers'Liability Disease-Policy limit f 500,000
Disease-Each Employee S 100,000
Other
Description of Operations/Locations/Vehicies/Special Items:
RE: Job No. 105536-02,470 Dundee Avenue,Elgin,IL. Amoco No. 19564. Certificate Holder is named as
Additional Insured.*
:.:«..<.:.:<.:.»..::.>.::.»..::.»..::.»..::.»..::.:.:<.:.::.:..<.:.>.<.:.>.:..:.::.>.<.:;.>.r..:.>.::.:.:.>.::.::.:.:.>.::.>.:<.:.::.>.::.>.::.::.>...........::.:.............G..#.~.I........A.......Q....N......;...... ............:< ..>..... >`><>< <.......:<> >> . ...........0 ff CX R#� :. A . : . ....;.>..>..:.:...>..>...>.>.>..?.<.......
..
Raymond H. Moller SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE
... EXPIRATION DATE ,s Director of City Properties DAYS WRITTEN NOTICE OF THEECERTIFICATOE HO DER ILL
AA
M ENDEAVOR D TOT EOLEFTIL BUT
City Of Elgin FAILURE TO MAIL SUCH NOTIC SHALL IMPOSE 0 ICI OR LIABILITY OF ANY
150 Dexter Court " KIND UPON THE COMPANY, AGENTS OR E I EE
><< Authorized Representat
Elgin,IL 60120-5555
t+tasQ�' s /9p? AARC► 109. �sao