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AC "R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) l +r.✓r 5/23/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 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 . PRODUCER CONTACT Kell Hartner NAME: y Schumacher Agency PHONE (989)435-7715 +nre,No►: (9S9)435-3071 E-MAIL 3r ADDRESS: ke11 hartner@schurnacherinsurance.com 215 South Ross Street P.O. BOX 548 INSURER (S�AFFORDINGCOVERAGE NAPA 132,905 Beaverton MI 48612 INSURERA:PROPERTY OWNERS INSURANCE CO INSURED INSURER B : INSURER C : Cops & Doughnuts LIC & 231 S Michigan St INSURER0: INSURER E : South Bend IN 46601 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1752303706 REVISION NUMBER: 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE NS13 51f9R _- _- POLICY NUMBER MMIDDfYYYY MIOYI DDIIYYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY - I CLAIMS -MADE ] OCCUR ! EACH OCCURRENCE _ DAMAGE TO RENTED PREMISES (Ea occurrencej $ 1,000,000 --- $ 300,000 33135327 1/7/2017 1/7/2018 MED EXP (Any one person) $ 10,000 I -- — PERSONAL & ADV INJURY ---- --------- $ 1,000,000 GEN'L X 1 AGGREGATE LIMIT APPLIES PER: JEUrPRO- POLICY LOG GENERAL AGGREGATE $ 1,000,000 PRODUCTS-COMPIOP,AGG, $, 00D 000 _-_ _.� -.____ OTHER: ! PremiseslOpera€ions ....,,,, ,,,,_.._-..r $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accsdeng $ l ANY AUTO BODILY INJURY {Per person) $ - - BODILY INJURY {Per accident) _ ALL OWNED SCHEDULED 'AUTOS NON OWNED HIRED AUTOS AUTOS $ I PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR 3 EACH OCCURRENCE $ Y EXCESS LIAR CLAIMS -MADE AGGREGATE $ DEO RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YI kl OFFICER/MEMHFR EXCLUDED? � NIA 33 i � PER 1.OTH- -___STA7 k TE.-_ ER..._ E.L.. EACH ACCIDENT - - - $ --- ---- ........... (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE$ IF yes, describe under DESCRIPTION OF OPERATIONS below -- --- E.L. DISEASE -POLICY LIMIT $ f E i � 3 � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schadute, may be attached N more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN South Bend, IN 46601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Steve Carland/KELLY O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered [narks of ACORD