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Certificate of Coverage Date: 10/27/2016 <br />Certificate bolder <br />cate is issued as a matter of information only and <br />The Diocese of Fort Wayne -South Bf:MI0843 <br />ights upon the holder of this certificate. This certificate <br />Chancery Office <br />end, extend or alter the coverage afforded below. <br />P O Box 390 <br />Fort Wayne, IN 46801 <br />rding Coverage <br />CATHOLIC MUTUAL RELIEF <br />IETY OF AMERICA <br />Covered Location <br />43 OLD MILL RD <br />St. Joseph Parish <br />OMAHA, NE 68154 <br />211 North St. Louis Blvd <br />South Bend, IN 46617 <br />Coverages <br />This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate <br />indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the coverage afforded described herein is subject to all the terms, exclusions and <br />conditions of such coverage. Limits shown may have been reduced by paid claims. <br />Type of Coverage <br />Certificate Number <br />Coverage Effective <br />Date <br />Coverage Expiration <br />Date <br />Limits <br />Property <br />rsonal Propeofire) <br />D. General Liability <br />rrence <br />ggregate <br />oFireDamage <br />Occurrence <br />omp/OP Ag <br />8679 <br />]0/1/2016 <br />10/]/2017 <br />® Claims Made <br />Adv Injury <br />(Anyone <br />Med Exp (Any one person) <br />Excess Liability <br />8679 <br />10/1/2016 <br />10/1/2017 <br />Each Occurrence <br />500 000 <br />Annual Aggregrate <br />Other <br />EAggregrate <br />Description of Operations/LocationsNehicles/Special Items (the following language supersedes any other language in this endorsement or the Certificate in <br />conflict with this language) <br />Coverage is verified for claims arising out of St. Joseph Parish's St. Nick Six Race in the City of South Bend on December 10, 2016. <br />Holder of Certificate Cancellation <br />Should any of the above described coverages be cancelled <br />before the expiration date thereof, the issuing company will <br />endeavor to mail 30 days written notice to the holder of <br />City of South Bend, Park & Rec Dept & Board of Park <br />certificate named to the left, but failure to mail such notice shall <br />Commissioners, 321 E Walter St, South Bend, IN 46614-2642 <br />impose no obligation or liability of any kind upon the company, <br />City of South Bend, Holy Cross College, Holy Cross Village at <br />its agents or representatives. <br />Notre Dame, University of Notre Dame <br />Authorized Representative <br />�� <br />0067003010 <br />