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�cca�n® CERTIFICATE OF LIABILITY INSURANCE �..,.-� DATE(MMIODIYYYY) 1/31/2017 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEDATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURGR(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certlllcate holder Is an ADDITIONAL INSURED, the policy(ies) must W endorsed, If SUSROGATION'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 endorsements , RODUCER Michelle Waaaaki libgon Insurance Agency, Inc. .30 S Main St, Ste 400 PH NS , {B00) BI4-2122 C 1, i0001e36-2122 EMAI6DiwagoekiQgibaanins,cam PO Box 11177 louth Bend IN 46601-0177 _ INSURER S AFFORDINQ COVERAGE NAIC# INSu ERA:Cinainnati Ins Ca _ 10677 ISURED wouRaae:Acoident Fund Ins Cc Amer 10166 INSURERC: ,a Cana do Amistad, Inc. 46 S Meade Street INSURERD: _ INsuRER e : ' :ouch Bend IN 46619 INSURERF OVERAGES CERTIFICATE NUM8ER!2/15/17-18 Y,iab Cart RFVISIAN NIIMRRR• THIS IS TO CERTIFY THAT THE 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 8R TYpI10PIN5URRNCEWVD POUPYNUMBFR PGBpYRF VI POLIO 8XP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR EACH OCCURRENCE $ 1,000,000 Ono$ 1,000,000- MEDFxp Anyone arson 4 10,000 ETD 0234322 2/15/2017 2/15/2018 PERSONAL& ADV INJURY $ 1.,000,000 GEN'LAGGREGATE LIMIT APPLIESPER: R POLICY❑JECTT LOC, GENERALAGGREGAT& 3 3,000,000 PROnuCTS•COMPIOPAGO 5 1,000,000 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGIE LIMit Eaaocldent) 3 1,000,000 A ANY AUTO ALL SOS AUTOS AUTOS HIRED AUTOS NON -OWNED _ AUTOB E2'0 0234322 2/15/2017 2/15/2018 BODILY INJURY (Per parson) 3 BODILY INJURY (Per accldanp $ PROPERTYDAMAGE ; $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMSUADE DEO RETENTION $ B WORKERS COMPENSATION AND EMPLOYER$' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUT€VE OFFICERIMEMeER WLUDED7 (Msndelory 1n NN) tie describe under 0SUtR€PTION OF OPERATIONS balwv N to WCV6099304 2/15/2017 2/15/2018 R E,L EACH ACCIDENT $ 500,000 E.L. DISEASE • EA EMPLOYE $ 500,000 111, DISEASE -POLICY LIMIT I $ 500,000 MSCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLE8 tACORD 101, Addilienel Rornarka Schedule, may be etlached i1 more space Is required) )0 NOT RENEW :ertifioate holder is additional insured with respect to general liability coverages an required by Britten contract. Board of Public Works 1316 County -City Building 227 West Jefferson 131vd South Bend, 2N 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIt S BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRIBtINTATIVE Iris Agency/MWASOS ACORD 25 (2014101) INS025 (2014011 (01968.2014 ACC The ACORD name and logo are registered marks of ACORD All rights reserved.