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- —^� KEVUKE-01 TARP <br />CERTIFICATE F LIABI : IT I S �i E DATE <br />CERTIF <br />'�•� 05EQ312018 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COFFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE .DOES NOT AFFIRMATIMELV OR NEGATIVELY AL"D, EXTEND OR ALTER TIME COVERA" AFFORDED BY TIME POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT_ H the certificate holder is an ADDITIONAL fNISURM the pohcy(ies) mulct have ADDFTtONAL RMURED prouLyrJ m of be eniarsed_ <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(s). <br />PRODUCER CONTACT <br />NAME: _ _ .. ....................... .. ... .... .... <br />Dan Berry Insurance Agency Inc. <br />54101 Ironwood Roast PHONE RG Ext): (57 4) 2.55-6222 : FAX nia):(574) 254-2630 <br />South Bend, IN 46637 L business@dbirnall.com <br />INSURER(S)AFFORDING COVERAGE }, NAIC 9 <br />INSIMER A: West Bend Mutual Insurance Co 16350 <br />INSURED asuRER6 'b".MtAua'l..I17S8.t anc '23043 <br />Kevin.J Kenney Dba K&R Tree Service INSURER C : <br />1724 South Grant MURER D <br />South Bend, M 46613 <br />;SURERE:.... <br />WSURER F : <br />rnvr=esnn1:c ['F0TI97it'aTI=9lI4l tRIZVa I?€`kFMQnNIAli 1AfiRrP- <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 <br />DOCUMENT WF H RESPECT <br />TO WHICH THIS <br />CERTIMATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR __-.. _.--- _.ADOL:SUOR _._._ ___.. ----- P01MYEFF POLICY EXP -. <br />TR TYPE OF INSURANCE SD yWD�. _ POLIGYNUER 17 YYY <br />� <br />LTS <br />IF <br />A j X COMWRML GENERAL L1AB&?TY <br />EACH OCCURRENCE <br />g 1,000,000 <br />CLAIMS -MADE X OCCUR 2128333. 08/11/2017 '. ORM112018 <br />-- -. ..PREMfSES.(Ea(ccwreace) <br />DAMAGE TO RENTED <br />.. <br />100,000 <br />; 5..... ..... .... ............. <br />5,000 <br />MED EXP (Arxp nne pef5onj <br />1,000,000 <br />- <br />L_... .. i........................................._............ <br />PERSONAL & ADV INJURY <br />. 5 ............... ... <br />2,OOfl,GOO <br />GEN'L AGGREGATE WAIT APPLIES PER: - <br />GENERAL AGGREGATE <br />: g <br />- POLICY S ', LOC '. <br />PRODUCTS - COhSPIOP AGG <br />OTHER: - <br />3 <br />A AuTOImOBILE LIAsam <br />C("INEO SINGLE LIMIT <br />(Ea acs) ... <br />300.000 <br />S. <br />-....._.._. ANY AUTO 2128333 0811112017 OSIIIIW18 <br />BODILY INJURY (Per P--) <br />' 1 <br />OWNED' ...... SCHEDULED <br />AUTOS ONLYAUTOS <br />DOWLY INJURY (Per acuderd) <br />. S <br />TOS ONLY _XANOUTOS ON-OWNEEDY' <br />X WED <br />AL._ <br />ibRbFERTY DAA,S/SGE <br />Ipnr acc>ieret) <br />4.. <br />5 <br />MUM" LIAR OCCUR ' - <br />EACKOCCUMENCE <br />�. S <br />EXCESS LAB CLAIMS -MADE <br />AGGREGATE <br />5 <br />DED RETENTION S <br />4 <br />B WORKERS COMPENSATION <br />X OERR- <br />AND EMPLOYERS LIABILITY :. <br />VIM WC5-39S-366202-017 05103I2018 ' 05I0312019 <br />.STATUTE <br />- <br />_ .. _... _. . <br />500,000 <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />E.L. EACI4 ACCIDENT <br />S <br />OFFICERIMFNIRER EXCLUDED? _kIA <br />in-Ntf) - - <br />500,000 <br />.. Mandatory : <br />E.L. DISEASE - EA EMPi.OYEF., <br />5 <br />If yes. descrMee uncW <br />500,000 <br />DESCRIPTION OF OPERATIONS below <br />f-L. DISEASE - POLICY LIMIT <br />S <br />DESCRIPTIONI OF OPERAIYIi4lS I LOCATION% I VO4CMS (ACORD IM, Addifiew l Remaa[rs Sc3edaAe, may he attached if mere space is requbedp <br />City of South Bend is listed as additional insured <br />I <br />I <br />f'FDTW1S'AT€.MnI nF0 f'Alhlf'FI I A'J'Tf1111 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />�. South Band <br />227 W. Jefferson Blvd. <br />THIS EXPTRATtDNkI DATE niEREOF, NORCE WILL BE DELIMERED IN <br />ACCORDANCE WITHTHEPOLICY PROVISIONS. <br />Suite 1200 N <br />Atr HORIZIED REPRESENTATME <br />South Bend, IN 46601 <br />ACORLI 25 (2016103) C� 1938-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are -registered marks of ACORD <br />