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ACl`O " l..�CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 0410912018 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 have ADDITIONAL INSURED provisions or lie endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an ondorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsoment(s). PRODUCER CONTACT Susan Thompson NAME: Laven Insurance Agency Inc. acoNr o EXt : (574) 291-5510 FAX, No): (574) 291-8505 E-MAIL suet@laveninsurance.com ADDRESS: R 0. Box 2379 INSURCR(S) AFFORDING COVERAGE NAIC 11 SOUTH BEND IN 46680 INSURERA: Frankonmulh MUtual Ins. Co. 13986 INSURED INSURER 0: INSURER C _ Tapastrie LLC INSURER D 103 W. Colfax Ave. INSURER F : South Bend IN 46601 INSURER F COVERAGES CERTIFICATE NUMBER: 17-18 Master 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 INSO WVO POLICY NUMBER P041CY EFF MM1D€IIYYYY POLICY EXP MMIPnIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 500,000 MED EXP (Any One person) $ 5,000 PERSONAL HAOVINJURY $ 1,000,000 A Y CPP6371889 10116/2017 10/1612018 GEN'LAGGREGATE LIMITAPPLIES PER: POLICY PRO- LOG SECT MOTHER: I GLNERAL AGGREGATE $ 2.000,000 PRODUCTS - COMPIOP AGG$ Z,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddenl 5 1,000.000 BODILY INJURY (Per Person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS IX BA6371869 10/16/2017 10/16/2013 BODILY INJURY (Per accident) 5 HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident) $ 5 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 5.000,000 AGGREGATE 5 5.000,000 A EXCESS LIAB CLAIMS -MADE CPP6371889 10/16/2017 10/16/2018 DEO I X RETENTION $ 0 5 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORlPARTNERIE7ECUTIVE ❑ OFFICERIMEMBFR EXCLUDED. (Mandatory In NH) if yes, describe under DESCRIPTION OF OPERATONS below NIA wG6371aE9 - 10/16/2017 - i01161'2018 - PER OTH- X STATUTE ER F,L.FACIIACCIDENT 5 500.000 _ E.L. DISEASE - EA EMPLOYEE $ 500,000 E,L. DISEASE - POLICY LIMIT 5 500,000 A Liquor Liability CPP6371689 10/16/2017 10116/2018 $1.000,000 $2.000.000 OCCUrrenCe Aggregole DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 104, Additional Remarks Schedulo, may be attached If more space is required) Location 103 W. Colfax Avenue, South Bend, IN 46001 CERTIFICATE HOLDER C AMrPI I ATlnkl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 125 S. Lafayette Blvd AUTHORIZED REPRESENTATIVE Suite 100 South Bend IN 46601 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD