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11/03/2017 FRI 17a19 FAX <br />i2011/016 <br />Certificate of Coverage beta, 10/2512017 <br />Certificate Holder <br />This Certilleate is Issued as a matter of information only and <br />The Diocese of Fort Wayne -South Band, Inc. <br />confers no rights upon the holder of this certificate. This certificate <br />Chancery Office <br />does not amend, extend or alter the coverage afforded below. <br />P O Box 390 <br />Fort Wayne, IN 46801 <br />Company Affording Coverage <br />THE CATHOLIC MUTUAL RELIEF <br />SOCIETY OF AMERICA <br />10843 OLD MILL RD <br />Covered Location <br />ST JOSEPH CHMCH <br />OMAHA, NE 68154 <br />216 N HILL ST <br />SOUTH BEND, IN 46617-0000 <br />This is to certify that the coverages listed below have been Issued to the certificate holder named above fvr the ear tilicate <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 coverage afforded described herein is subject to all the terms, exclusions and <br />conditions of such coverage. Limits shown may have been reduced by paid claims. <br />'typo of Coverage <br />CertlRcale Number <br />Coverage Ellective <br />Dato <br />Coverage Expiration <br />Date <br />mmHg <br />Property <br />Real & Parronal Property <br />D. General Mabtlity <br />EiLch aecilrreace <br />500 000 <br />General Aggregate <br />®✓ Occurrence <br />© Claims Made <br />I0/1/2017 <br />10/1/2018 <br />ftoductd-Comp10P An8679 <br />pcisonA&AdvInjury <br />Fire Damage (Any one tire) <br />r ed lixy (7fly one Parton) <br />Ercers Liability <br />8679 <br />10/1/2017 <br />10/1/2018 <br />Moab 0ccurrence <br />500000 <br />Annual Aggregrate <br />Other <br />aeli Weurrenco <br />Claims Made <br />Annual Aggregrale <br />LSmltlCoversge <br />DosCripgon of plsarattonell oaatlaaMfVehlclaelsipuatal llelna (the loltowing language tnpereedel any other language In this andoraemont or the Certllteate in <br />aonliict with this toq"a&) <br />The City of South Bend and its rospcetive elected officials, officers, employees, agents and representatives; Board of Park <br />Commissioners, and South Bend Venues Parks & Arts are named additional protected person(&) but only for claim& arising out of St. <br />Joseph Churcifs St. Nick Six Race in the City of South Bend on December 2, 2017. <br />Holder of Cerdficato ConjOletton <br />Additional Protected Person(s) <br />Should any of the above described coverages be cancelled <br />before the expiration date thereof, the issuing company will <br />endeavor to mull 30 days written notice to the holder of <br />City of South Bend,IN, 227 W Jefferson Blvd, South Hand, IN <br />oertflcate named to the left, but failure to mall such notice shall <br />46601., South Bend Venues Arta & Parks, 321 E Walter St, South <br />Bend, IN 46614; Board of Park Commissioners, 321 E Walter St, <br />South Bend, IN 46614 <br />0067003298 <br />impose no obligation or liability of any kind upon the company, <br />its agents or representatives. <br />Authorized Repreeen metve <br />