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EPOCH-1 OP ID: CH ACorry CERTIFICATE OF LIABILITY INSURANCE . 44 GATE (MMlDDIYYYY) 07/10/2017 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 be 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 Ileu of such endorsement(s). PRODUCER R.S. Miller & Sons, Inc. P.O. Box 229 P.O. 109 W. Plymouth Street Bremen, IN 46506 CONT CT Gregory S. Miller, CPCU,CIC No E t , 574-546-3341 AIC No): 574-546-2687 E-MAIL ADDRESS: Gregory S. Miller, CPCU,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual Insurance Co. 24082 INSURED EpochArchitecture+Planning LLC Kyle Copelin 300 W. Jefferson Blvd. INSURER B:LIbe !nkernationa! Underwri 24082 INSURER C: Pekin Insurance Company 24228 South Bend, IN 46601 INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 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 OD €NSD BR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM1DDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR BZS 57342600 06I2712017 06/27/2018 EACH OCCURRENCE $ 1,000,00 DAMAGE TORENrEff- PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ INCLUDE GENT AGGREGATE LIMIT APPLIES PER: HPOLICY PRO JECT L_._l I I LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS-COMPIOPAGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED X HIRED AUTOS AUTOS BZS 57342600 06/27/2017 06/27/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PeOPLc' n )AMAGE $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS` LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE Y�N1A OFFICERIMEMBER EXCLUDE O7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below WC000469OG 02/06/2017 02/06/2018 STATUTE X ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE 600,00 E-L. DISEASE - POLICY LIMIT $ 500,00 B Professional Liabi $5,000 Ded 05312016 06/10/2017 06110/2018 Ea Claim 1,000,00 Ann Aggr 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) C'RI-rIr:IC'GTE HOLDER CANCELLATION CITYSBI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson AUTHORIZED REPRESENTATIVE Gregory S. Miller, CPCU,CIC South Bend, IN 46634 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD