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YMCAO-2 OP III: TJ <br />4.. I CERTIFICATE OF LIABILITY INSURANCE D 0711 1201 YY) <br />o7r12r2a1s <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FLIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMA71VELY 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(tes) must be endorsed. If SUBROGATION 15 WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cerlilicato does not confer rights to the <br />certificate holder in lieu of such endorsements . <br />caNrA <br />PRODUCER NAME: <br />TCU Agency, LLC PHONE u <br />426 Lincolnway East MAIL <br />Mishawaka, IN 46544 ADD":ss• <br />GaryD.Wlesel -`tN$URP- gIAFFORo1NGCOVERAGE <br />MMIMMR A -National 5aeciaity Insurance <br />INSURED YMCA ofMlchiana. I suRERs: <br />1201 Northside Blvd. INsuRERa: <br />South Bend, IN 46616 — — - - <br />—THIS.IS TS3CERTIFI' Tk3AZ.iI�E.PCZiCCIES_OFJL1541FiflNl h )j:.l..tl�.It3»SZ6v.oGGIV_...._.r .--.-s_. <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT Ta 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 />IN <br />R AD PO C EFF POLCYExP LIMITS <br />7YPEOFINSURANCE POLCYNU UMBER .MMfD DD <br />EACH o <br />(3ENIsRALL1ABELITY r.GURRIrP10E 1,UO0,i <br />5 <br />A X COMME ACIALGENERALLIASILITY 3( NSE 21Q4469 0710112018 0710112017 PREMSE= OLQUIF Ice $ 100,[ <br />CLAMS -MADE � OCCUR MED EXP one person)$ri <br />_........_. a nnn r <br />A <br />A <br />A <br />NIA <br />N5F2104409 <br />iUUp2104480 <br />CF291$934 <br />NSF2113693 <br />0710112010 <br />07101l20190710112Q17 <br />07101/2016 <br />0710112018 <br />0110112017 <br />0710112017 <br />071o112017 <br />GENERALAGGREGATS <br />S a <br />PRODUCTS-COMPIOPAGO <br />S-71 1 <br />GEN'LAGOREGATEUMR'APPLIES PER., <br />POLICY PRO LOCI <br />AUTOMOBILE LIABILITY <br />3C ANYAUTo <br />ALLOWNEDk8AUTOS <br />AUTOS: <br />HIRED AUTOSX UMBRELLA LIAR <br />EXCESSLIAS <br />Emp Bon, <br />COMBINED 51NG E; LIMU <br />a den <br />S 1 <br />3 <br />BODILY INJURY (Per parson) <br />$ <br />BODILYINJURY(Per accident) <br />$ <br />EORACCI <br />EACH OCCURRENCE <br />$A <br />AGGREGATE <br />$ <br />�p <br />X QRYL.E � ER <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LMILITY <br />OOFFRCUR/PMEMBERPEXcLcLUnID?ecunvE Y� <br />(MandatoryIn NH) <br />IIMy.RI"r11nu"do, <br />DE6L'RiPiION OP OPERATIONS Lelow <br />jMl Auto Coverage <br />E.L,EACH ACCIDENr <br />$ <br />E.L,tHSEASE-EA EMPLOYE <br />$ <br />E.L.13MLASE-PO€IUYLIMIT <br />Liability <br />$ <br />, <br />1 <br />DESCRIPTION OF OPERATIONS I LOCATIONS ivEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If Mare space IS required) <br />-The City of South 38end and the Board o;ff paik Commisoioners are additional <br />i.nsuredra on the general liability in accordance With all terms, conditiona & <br />limitations o:E the policy and then only with respect to the Michiana 3 for 3 <br />Triathlon. <br />City of South Bend <br />Board of Public Works <br />227 W. Jeffferson Blvd. <br />1200 County -City Building <br />South Bond, IN 46604 <br />ACORD 25 (2010T05) <br />CITYSBB <br />SHOULD ANY OF THE ABOVE D>SCFiIBEwO POLICIES BE CANCELLED BEFORE <br />THE: EISPERATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTA71VE <br />01988-2010 ACORD CORPORATION. All rights reserved. <br />"The ACORD name and logo are registered marks of ACORD <br />