Laserfiche WebLink
CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MWDDIYYYY) <br />0410612017 <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 pollcy(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 />certificate holder In lieu of such endorsemenl(s). <br />PRODUCER <br />Randy Lellaert Agency Inc <br />410 Lincoln Way W <br />CAMEACT Michelle Harrell <br />PHONE IFA No): 574 674 9582 <br />o Iss <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA: Illinois Casualty Company <br />Osceola IN 46661 <br />ENSURED <br />INSURER B : <br />INSURER c: Illinois Casualty Company <br />Frank's Place <br />INSURERD: <br />327 W. Marlon St. <br />INSURER E: <br />INSURER✓=: <br />South Bend 1N 46601 <br />�n�Ir QAr��e, rt PTtFlC`ATF MI ]MR FIR' REVISION NUMBER: <br />vTHIS IS TO CERTIFY THAT THE POLICIES OF INSURPACE LISTED BELOW HAVE BtrN ISSUER TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTAUDING 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 />TYPE OF INSURANCE <br />ADD <br />SUBi1 WD <br />POLICY NUMBER <br />MM [31)YIYEYYY <br />MIOs710 Y EXP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />X <br />BP38296 <br />1/1/2017 <br />1/1/2018 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PAEASES E o TE gggano.ol <br />$ <br />MED EXP (Any one person)$ <br />PERSONAL&AOVINJURY <br />$ <br />GEN'LAGGREGATE LIMIT APPLIESPER: <br />POLICY ❑ jECT LCsC <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS-CRMPlOP AGG <br />$ <br />$ <br />AUTOM08(LELIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS <br />NON -OWNED <br />HIRED AUTO B AUTOS <br />(Eag V,ant, LE LIMIT <br />Ea en! <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per acdderlt) <br />$ <br />7(,).P ride ,DAMAGE <br />$ <br />C <br />UMBRELLA LMB <br />EXCESS LIAB <br />OCCUR <br />CLAIM&MADE <br />UL15829 <br />1/1/2017 <br />1/1/2018 <br />EACH OCCURRENCE <br />S 1,000,000 <br />AGGREGATE <br />$ <br />DED I I RETENTION <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORIPARTNI:RlrXECUTIVE N <br />OFFTCF-RIMEMBEREXCLUDE N <br />(Mandatory In NH) <br />Ryas descrlheunder <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />PER OTH- <br />STA7 UTF <br />EE,L.EACH ACCIDENT <br />$ <br />EL. DISEASE -EA EMPLOYE <br />$ <br />E,L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlortsl Rsmsrks Seliedulo, may be attached it more space Is requited) <br />CERTIFICATE HOLDER IUIII <br />CITY OF SOUTH BEND SHOULD ANY OF THE ABOVE DESCRIBEU POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />L- :1 <br />O 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />