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CERTIFICATE OF LIABILITY INSURANCE <br />DATE MMNCIWYY) <br />8�11/2016 <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 policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />Surplus Insurance Brokers <br />P. O. Box 749 <br />South Bend IN <br />46624-0749 <br />INSURED <br />46615 <br />COVERAGES <br />..vwluly NUMULM <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br />PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH <br />THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT <br />TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REIXJCED BY PAID CLAIMS. <br />Ias I <br />LTR TYPEOF INSURANCE OLe POLICY NUMBER MIN CY EF NoLIC LIMITS <br />LIMITS <br />A X OCMMERCIALOENERALUABIL" X CP02716060-01/17/2016 9/18/201 EACH OCCURRENCE 3 1,000,000 <br />CLAIMSMADE OCCUR <br />PREMISES ao:unanpa $ 100,000 <br />MEDENP(Ally OnepammU 4 5,000 <br />PERSONAL& ADVINARY $ 1, 000, 000 <br />OENLMGREGATEUMITAPPUEBPER GENERAL AGGREGATE 3 2, D00, 000 <br />X POLICY a P„ECy LOC <br />PRODUCTS-COMPAlPA00 3 2, 000, 000 <br />OTHER S <br />AUTOMOBILELM01ITY <br />COMBINEDS1 LE LIMT <br />ocUMl <br />S <br />ANYAUTO <br />BODILY INJURY(Peroomon) <br />3 <br />ALL OUNED SCHEDULED <br />SODILYINJURY&raapeeU <br />3 <br />AUT09 AUTOS <br />HIRSDAUTOS NON.OWNED <br />AUTOS <br />H <br />PROPERTY DA <br />.. <br />3 <br />- <br />UNBItEUA <br />OCCUN <br />EACH OCCURRENCE <br />3 <br />EXCESB LIAS <br />GLNMGMADE <br />AGGREGATE <br />S <br />CEO RETENTIONS <br />S <br />SYORKERSCOAPBISATION <br />ANDEMPLOYEAV U M ITY YIN <br />STATUTE ER <br />ANYPRCPRIETg ARTNERIE%ECITPIE <br />FCERIMFl,1BER EKCLUOEDF <br />NIA <br />E.L.EACH ACCIDENT <br />3 <br />(Mandatory Ie NH) <br />IN <br />B Yyaaa d,acrtau der <br />DEBCPoPTION OF OPERATIONS We, <br />El. DISEASE-EAEMPLOYE <br />S <br />E.L. DISEASE- POUCY LIMIT <br />S <br />DESCRIPTIONOPOPERATIONSILOCATION&/V6aCLEa (ACORO 101,AdJK1arml Ramm*m Schoub, may be aeeceed a mare Spec, IS m,u1m) <br />GROUP 1-SPECIAL EVENT <br />CERTIFICATE HOLDER IS AN ADDITIONAL INSURED PER FORM CG2026(04-13). <br />CITY OF SOUTH BEND <br />BOARD OF PUBLIC WORKS <br />1316 COUNTY CITY BLDG <br />227 W JEFFERSON BLVD <br />SOUTH BEND IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />reserved <br />^�� •� (...•.,+•+v I ne AUUKU name and logo are registered marks of ACORD <br />(OMNI7 CERT004-130729/1608111039) <br />