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Bt1SIN-2 OP ID: MM DATE IMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12107/2017 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(les) must he 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 endorsements . PRODUCER CONTACT NAME: Lynn Chlu TCU Agency, LLC PHONE FAx --- 426 Lincoinway East Arc, Np,xx):.574-258-6ii70 _ Arc Ho : 574-252-2109 Mishawaka, IN 46544 Mark A. Mondientz, GIG -AD DRREESS: _ INSURER A: continental Western 10804 INSURED Business Furnishing LCGI_l OCUS INSURERS: �... Audio VisuaUlnfinium Floors 4102 Meghan Beeler Ct INSDRERC: - _ South Bend, IN 46628 MAURERD: INSURER E : INSURER F : r_nvFRArZFS nonTir-inikTF ut iMFZFR• RFMAICIN NIIMAF:R, 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 -- -- TYPE OF INSURANCE POLICY EFP POLICY F_XP LIMITS LTR POLICY NUMBER MM1DDiYYYY MMIDDNYYY A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 111000,000 CLAIMS -MADE Fx] OCCUR X ADV 3157686-10 12/31/2016 12/3112017 pREIAISE aocaEOnaa S 600,000 MED EXP (Any one person) S _ 15,0()0 $ 1,000,000 PERSONAL & AGV INJURY OEN't AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOG $ 2Aoo,00 PRODUCTS COMPlOPAGG — $ OTHER; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT eeident $ 1,000,000 X BODILY INJURY (Per person) A ANY AUTO CPA 3167735-11 12131 /2016 12/31/2017 $ ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDADTOfi Lk AUTOS BODILY INJURY {Per accident) $ $ _-- X PROPERTYiIAMAGE Per aCc4dertl $ X UMBRELLA LIAR: X OCCUR EACH OCCURRENCE $ S,t}DO,OOO _.. AGGREGATE - A EXCESS LIAB CLAIMS -MADE CAA 3157736-11 1213112016 1213112017 $ 5,000,000 DED 1 X RETENTIONS 0 FOLLOW $ FORM A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECUTIVE YIN OFFICERIMEMSER EXCLUDED? (Mandatory In NH) N f A CA3157688-10 12131/2016112/3112017 I PFATUTE X ER - _ $ 600,000 E.L. EACH ACCIDENT E.I I. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 0 es describe under SGtRIPPON OF OPERATIONS below I ? $ 500,000 DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD zap, Addlllonal Remarks Schedule, may be attached if more apace Is required) RZ; Morris Bistro/Palais Lobby Improvements, 211 N Michigan St, South Band, IN The City of South Bend is additional insured per the attached form. !_Fl?TIPICIATR uAI nr-0 r AAIf`_1Kl I ATIANI CITY002 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Band THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Board of Public Works County City Building South Bend, IN 46601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reservea- ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD