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rrI DIANrA FARM. BUREAU 1AISURANCE0 <br />NAMED INSURED AND ADDRESS: <br />LIVING STONES CHURCH <br />718 DONMOY13R AVE <br />SOUTH BEND IN 46614 <br />CERTIFICATE OF INSURANCE <br />CERWICNI V ISSUED TO: <br />CITY OF SOUTH BEND <br />1316 COUNTY CITY BUILDING <br />227 W JEFFERSON BLVI) <br />SOUTH BEND, IN 46601 <br />This is to coriify that the policies fisted In this CcrliFicale hive been Issued to file Named lusu red by <br />❑A UFA CASUAUCY INSURANCE COMPANY ® UNITED FARM FAMILY MUTUAL INSUIIANCE COMPANY <br />The policies of insurance Its led on this certificate have been issued to 411e insurgd named above for Into policy period Indicated. Notwithstruiding any <br />requhmntent, term or condifian ofany contractor other document ►v111t respect to which this Certificate may be issued or may portain, Ilia hisunulce nfiorded <br />by the policies described Is subject to all terms, exclusions and condlilons of such policies. Aggregate limits shown may have been reduced by Paid claims, This <br />Cerfificalc of Insurance does aolconstitute a contract between file issuing Insurer(s), authorized represcolative or producer, and the certificate balder, nor (loos <br />it affirmatively or ieegativoly ahead, extend, or after the coverngo afrorded by the policies listed thereon. <br />'I�Tc ar Insurance <br />Policy Number <br />Company <br />Effective <br />Expiration <br />Limits of Llnbility <br />(AIB) <br />Date <br />Dnte <br />COMMERCIAL LIABILITY <br />CHU870159205 <br />B <br />12/05/2016 <br />1210512017 <br />General Aggregate <br />$3,000,000 <br />( X] Commorcial General Liability <br />Prod,•Comp/OPS Aggregate <br />$3,000,000 <br />[ X) Occurrence <br />Persona! Advertisinglnjuty <br />$1,000,000 <br />Each Occurrenco <br />$1,000,000 <br />Fire.Dama$e (Any one fire) <br />Med Expanse (Any one person) <br />S5,000 <br />FARM LIABILITY <br />Each Occurrence <br />[ ] Rgldlle <br />Ned Expense (Ally olio porson) <br />[ } Occurrence <br />COMM, AUTO LIABILITY <br />CIliU870159205 <br />B <br />12/0512016 <br />12/05/2017 <br />Each AcOdenf <br />[ ] Scheduled Autos <br />Mod Expense <br />] X] I-Ilred Autos <br />[ ] Non -Owned Autos <br />FARM AUID LIABILITY <br />Each Aceident <br />[ ] Scheduled Autos <br />Mad rquilse <br />[ ) Hired Autos <br />[ ] Non -Owned Autos <br />UMBRELLA LIABILITY <br />UMB860267805 <br />11 <br />1210512 116 <br />1210512017 <br />Each Occurrence <br />Aggregate <br />51,004,000 <br />WORKERS, <br />Stalutory - bidimaa <br />COMPENSATION <br />Each Accident <br />AND <br />Disease Policy Limit <br />RIVIPLOYERS' LIABILITY <br />Disease Dealt Employee <br />OTHER <br />DESCRIPTION OFOPERATIONS, <br />10CATIONS. VEHICLES, <br />RESTRICTIONS, <br />AND <br />SPECIAL ITEMS <br />Additional Insured: City of Soulli Rend <br />Irsubrogalion is waived, subject to tare terms and conditions of ilia policy, eorWit policies may require an endorsement. A statement on this Certificate noes not <br />confer rights to flrccertificale holder in lieu orsuch cadorsement(s), <br />Should tiny of the described policies be canceled before the expiration date, tile, Issuing Insurer wig make an ellort to notify the certificate holder named, but <br />flifure to do so shall impose no obligaflon or liability of any kind upon the insurer, its agents or representatives, <br />JON H BACKSTROM 06/2612017 <br />Agent Dale <br />574-291-3840 <br />PIIUIIe <br />06.996 3-12 [ ] Ceriificate Holder's Copy [ ] Home OMac Copy [ ) Agency Copy [ ] insurcd's Copy Page I of I <br />Printed: 06/2612017 03:28:56 PM <br />