Procession - Stanley Clark School

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ACC?RV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YM) s/13/2017 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 endorsement(s). PRODUCER Gibson Insurance .Agency, Inc. GONTACT Stephen Swihart NAME: PHONE (800) 814-2122 FAf No: (800)636-2122 130 S Main St, Ste 400 E-MAI ADDRESS: gL sswihart@ ibsonins.com INSURER S AFFORDING COVERAGE NAIC # PO Box 11177 INSURERA:Cincinnati Insurance Co South Bend IN 46601-0177 INSURED INSURER e;ACcident Fund Ins Co .Amer 10166 INSURERC: _ The Stanley Clark School, Inc. INSURERD; 3123 Miami Street INSURER E : INSURERF: South Bend IN 46614-2098 rnvPPAnPR rFRTIFIrATF NIIMRFR-17 /l8 Liab 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR PREMISE,(Ea oceTu ence $ 500,000 M£DEXP(Any one person) $ 10,000 SIP0008277 7/1/2017 7/1/2018 PERSONAL& ADV INJURY $ 1,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPlOP AGG $ 31000,000 JECT POLICY PRO- ❑ LOC Employee Benefits $ 3., 000 , 0 00 11 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidani $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NO OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ _ $ j UMBRELLA LIAR EACH OCCURRENCE $ 10, 000, 000 HOCCUR AGGREGATE $ 10, 000, 000 A EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ SIP0008277 7/1/2017 7/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIVE IPER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500, 000 E.L. DISEASE -EA EMPLOYFd $ 500,000 B OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N ! A WCVG113731 7/1/2017 7/l/2018 E.L. DISEASE - POLICY LIMIT $ 500,000 IF yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (ACORD lot, Additional Remarks Schedule, may be attached If more space is required) The City of South Bend is additional insured with regard to General Liability as required by written contract or agreement for the Clark Run on October 14, 2017. r P0TIGIr'_ATF I-Inl nF=P CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 227 W Jefferson Stt ACCORDANCE WITH THE POLICY PROVISIONS. South Bend, IN 46601 AUTHORIZED REPRESENTATIVE G Ins Agency/STSWIH ©1988-2014 ACORD CORPORATION. All rigiats reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 /9ntarHl