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® A`C� o CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 4/17/2017 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 Leven Insurance Agency Inc, 2628 S. MICHIGAN STREET P . 0. BOX 2379 SOUTH BEND IN 46680 CONTACT Susan Thompson PHONE _tj, (574)291-5510 C No:(574)291-8505 E-MAIL suet@laveninsurance.com ADDRESS: INSURER S AFFORDING COVERAGE NAIC # INSURERA:Peerless 24198 INSURED South Bend Community School Corporation 215 South Dr. Martin Luther King Jr. Blvd. South Bend IN 46601 INSURERB:Indiana Insurance 22659 INSURER C D; -INSURER INSURER E INSURER F : 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 ADO UBR POLICY NUMBER M_iliMID�rYYYY7EACH LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X CBP9381640 3/13/2017XP OCCURRENCE $ 1, 000 , 000 O RENTED SES Ea occurrence $ 300 , 000 (Any one person) $ 15,000 NAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY COT� LOC X ❑ JE RAL AGGREGATE $ 2 , DOO , 000 PRODUCTS-COMPIOPAGO $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY Ea agcidaDtSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS A NUTOS NED X HIRED AUTOS X AUTOS BA9143886 3/13/2017 3/13/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE accident) $ _[Per Underinsured motorlst $ 1,000,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B EXCESS LIAB CLAIMS -MADE CU9719162 3/13/2017 3/13/2018 OED X RETENTION 10 000 WORKERS COMPENSATION PER OTH- STATUTE ER $ E,L.EACHACCIOENT $ AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNEWEXECUTIVE _ E.L. DISEASE - EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? ❑NIA (Mandatory In NH) E,L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add€tlonal Remarks Schedule, may be attached If more space Is requlred) Event: Homecoming Parade September 8, 2017-Riley High School Certificate holder and the City of South Bend are named as additional insureds. (574)235-9171 lmartin@southbendin.gov Board of Public Works 227 West Jefferson Blvd 1316 County City Building South Bend, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Susan Thompson/SMT ©1988.2014 ACORD CORPORATION. Al('rights reserved. AG(JKU Zb tZU141U'I J ...... ... ..._W ..,.. y, INS025 fgnunl �