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CANNWAT441 KRLnssER
<br />AcoRO" CERTIFICATE OF LIABILITY INSURANCE
<br />`•�
<br />DATE(MMIODIYYYY)
<br />12111 /2017
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATiON IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement($).
<br />PRODUCER
<br />1st Source Insurance, Inc.
<br />6909 Grape Road
<br />Mishawaka, IN 46545
<br />CONTACT Kris Slosser
<br />PnHic°,N ;, Ext ; (574) 271-5200 �A' c,(574) 27 #-5240
<br />----___._ _..__ -...._ _--
<br />�e[o�,$,blosserk@istsource.com
<br />D ,$, blosserk@lstsource.com
<br />INSURERS) AFFORDING COVERAGE
<br />_ _NAIC
<br />INSURER A: Frankenmuth Mutual Ins Co.
<br />13986
<br />INSURED
<br />INSURER B :
<br />..109URERC:..,.....—.....-
<br />Canney's Water Solutions, Inc
<br />1205 Mishawaka Ave
<br />South Bend, IN 46615
<br />INSURER D : ......,____.....
<br />— —
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />_EXCLUSIONS
<br />INSR
<br />. _,.,.._.....,.,,_._—TYPE OF INSURANCE
<br />AODL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY E.XP IMMIOVIYYYYI
<br />LIMITSLTR
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE L: OCCUR
<br />CPP6363066
<br />07120/2017
<br />07/2012018
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />PREMISES E urrence
<br />$ 1,000,000
<br />500,000
<br />$
<br />GEN'L
<br />X
<br />MED EXP An one_ erson ._,
<br />PERSONAL&ADV INJURY
<br />5,000
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JECT LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS
<br />2,000,000
<br />_$—
<br />A
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY _ AUTOS pp
<br />-- 2TOS ONLY Ai0i 05 ON Y
<br />BA 6363065
<br />0712012017
<br />0712012018
<br />CEOMBINED SINGLE LIMIT
<br />1,000,000
<br />BODILY INJURY_(Per arson
<br />8001LY INJURY Per accldeot
<br />$
<br />(Pea Kent AMAGE_.,........__.,_
<br />.$_.__....._......_ . ..._._._...__.........
<br />is
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAR
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />CPP6363065
<br />07/2012017
<br />07/20/2018
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE _ _-..,..,....__-
<br />_ 2,000,000
<br />$
<br />DED I X I RETENTION$ 0
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y I N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />WFICERIMEMS R EXCLUDED?
<br />andatory In NH)
<br />If s
<br />CDIPTION OF OPERATIONS below
<br />N I A
<br />WC 6363065
<br />07/2012017
<br />0712012018
<br />7C PER OTH-
<br />E.L. EACH ACCIDENT
<br />500,000
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />544,444
<br />$
<br />E.L, DISEASE - POLICY LIMIT
<br />504,000
<br />DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CFRTIFlr.ATF FIC]I r1FR CANCFI. LATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Morris Performing Arts Center
<br />9
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />211 Dr. MLK Jr. Dr
<br />South Bend, IN 46601
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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