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CORVINC-01 <br />`-f CERTIFICATE OF LIABILITY INSURANCE <br />QQM <br />DATE(MMIDDIYYYY) <br />1 312812017 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsements). <br />PRODUCER <br />The Campbell Group <br />PG Box 1788 <br />Grand Rapids, MI 49501 <br />UNTACT Mallssa DeVormer <br />PHONE 616) 541-1458 FAX <br />(AIC, No, Ext): 1 (AIC, No): <br />na,RLss: mdevormer@thecalnpbeilgrp,com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURERA:West Bend Mutual Insurance Co <br />15350 <br />INSURED Corvllla Inc <br />3620 Deahl Court <br />South Bend, IN 46628- <br />INSURER 9 : <br />INSURERC: <br />INSURERD: <br />INSURER E <br />INSURER F <br />r.nVFRAr.F.% f'.FRTIFIrATF kil IURPP- RNAlr¢InN M"RARF17- <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, 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 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 />LTRrn <br />TYPE OF INSURANCE <br />A g L <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 1K OCCUR <br />Y <br />N <br />A260199 00 <br />8120/2017 <br />8/21/2017 <br />EACH OCCURRENCE <br />1,000,000 <br />F'EV Esn R nNTED - <br />$ 100,000 <br />MED EXP (Any one personi <br />PERSONAL & ADV INJURY <br />1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY JECT LOC <br />OTHER: <br />GENERAL AGGREGATE <br />3,000,000 <br />PRODUCTS- COMPIOP AGG <br />3,000,000 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED F I SCHEDULED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY Alni OS ONLY <br />COMBINLide.D SINGLE LIMIT <br />Ea :r <br />BODILY INJURY Perperson) <br />BODILY INJURY (Per accident <br />Panracc�en1DAMAGE <br />UMBRELLA LIAR <br />EXCESS LIAR <br />HCLAIMS-MADE <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />DED I I RETENTION $ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LiABILITY YIN <br />ANY PROPRIETgO�R�IPARTNER)EXECUTIVE <br />I F15afory n NW) EXCLUDED? <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N I A <br />PER OTH- <br />STATLTfE ER <br />E.LL EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYE <br />EL. DISEASE- POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space is required) <br />City of South Bend <br />1200 County City Bldg <br />South Bend, IN 46601-0000 <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 <br />