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FIDDHEA-01 ILPRIV <br />,ac`o/zv` CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDO YYYY) <br />02I23/2017 <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 <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of <br />PRODUCER <br />INSURED <br />Fiddlers Hearth, Inc. <br />127 N Main St <br />South Bend, IN 46601.1608 <br />must have ADDITIONAL INSURED provisions or be endorsed. <br />certain policies may require an endorsement. A statement on <br />aK°� Ftll• t5741271-6000 1(No.No):(574) 243-3214 <br />REVISION NUMBE <br />I Uvmn wm� <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTVVITHSTANDING 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 INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />OFINSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY <br />EFF <br />POLICYEXP <br />LIMITS <br />JORTYPE <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADErVI OCCUR <br />X <br />CPP1889176 <br />08l18I2016 <br />09/1812017 <br />EACH <br />$ 1,000,000 <br />DAMAOETORENTED <br />_PHEMISEfi <br />-OCCURRENCE <br />(EIX' <br />.600,000 <br />MEDEXP Ann one arson <br />S,906 <br />PERSONAL&ADVINJUR_Y <br />1,000,000 <br />OWL AGGREGATE LIMIT APPLIES PER: <br />X POLICY ❑ jEDT O LOC <br />GENERAL AGGREGATE <br />$ 2'600'000 <br />_ <br />PRODUCTS-COMPIOPAGG <br />2,000,000 <br />COMBINEDSINGLE LIMIT <br />(En 0dtl 11 <br />1,000,000 <br />A <br />OTHER: <br />AUTOMOBILE LIABILITY <br />BODILY NJURY /Per paean) <br />ANY AUTO <br />BA 1999176 <br />09/1812016 <br />09M812017 <br />__S. <br />BODILY INJURY PgAp dant <br />AL�pIT�0�60NLY SCHEDULED <br />X AUTOS ONLY X AUTOS ONTY <br />OaPER Y AMAGE <br />$ <br />A <br />X <br />UMBRELLA LIAR <br />EXCESS LIAR <br />LX1 <br />OCCUR <br />CLAIMS -MADE <br />CPPI999176 <br />09/1012016 <br />0911612017 <br />$ 6,000,000 <br />-EACH -OCCURRENCE <br />AGGREGATE <br />61000,000 <br />DED RETENTION$ <br />A <br />A <br />WORRIERS COMPENSATION <br />AND EMPLOYERSLIABILITY Y <br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑ <br />OFFICCEEppIMEMU, EXCLUDED? <br />andelory In NH) <br />DYae�RIPTION OFO RATIONS babes <br />Liquor Liability <br />NIA <br />C 1999176 <br />CPP1999176 <br />0911812016 <br />09/1822016 <br />0911812017 <br />09/1812017 <br />I PER LOTH. <br />E.L. EACH ACCIDENT <br />100,000 <br />E.L. DISEASE -EA EMPLOYE <br />_ <br />100,000 <br />E.L. DISEASE -POLI VLIMfT <br />600,000 <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Addlllonal Remark$ 8014e010, may ea a8aoned Umme apkco Is rogdlrod) <br />City of South Bend Is named an additional insured with respect to General Liability. <br />City of South Bend <br />South Bend, IN 46601 <br />Acnon oe I9n4am'n <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 />AUTHORIZED REPRESENTATIVE <br />(a)1998.2015 ACORD CORPORATION. All viable reserved. <br />The ACORD name and logo are registered marks of ACORD <br />