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0 ACCI► V CERTIFICATE OF LIABILITY INSURANCE DATE (MM001YYYY) 04/111201 s 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 t3Y 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 Bolder s an ADDITIONAL INSURED, the policy(ies) 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 rigtlts to theI certificate Holder in liett of Such endorsement(s). Randy Leliaert Agency Inc Lincoln Way W Osceola IN 46551 CONPRODUOCK Michelle Harfell FAX (674 674-9582 No:410 FIN1,AW01 INSURERMAFFORUINGCOVERAGE NAICN INSURFRA: Illinois Casualt Com any 000000 INSURED Frank's Place 327 W. Mallon St. South Bend. IN 46601 INSUiiE_R 9 t Illinois Company ..... -- -- ---- 000000 _Easualty INSURERC: IlfinoiS Casualty ComY1 any 000000 INSURER 0: INSURER C INSURERF— IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS 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, DDL SU8F2' - POLICY EFF POLICY EXP ILTR TYPE OF ENSURANCE POLICY NUM9ER fAWODIYYYY MMI17DA'M LIMITS X COMMERCIAL GENERAL LtABIL11Y EACH OCCURRENCV $ 1,000,000 DAMAGETD ENTEO $ CLAIMS=MAOE OCCUR PREMI Ea occu Ice $ MED EXP(Any one p&sonj A N N BP88296 011011201E 01/01/2019 PERSONAL & AOV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ POLICY PRO ❑ LOC $ JECT OTHER: COeccidentSINGLELIMIT $ AUTOMOBILE LIABILITY BOUILYINJURY (Per pefs0n) S ANY AUTO RODILYINJURY (Per aceldenl) $u ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED PROPERTY DAMAGE a accident $ HiREDAUTOS AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE C EXCESS LIAB_ CLAIMS-MAUE N N UL16829 01101/2018 01101/2019 OCD RETCNTIDN$� ER H _ $ WORKERS COMPENSATION STATUTE ER _. AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOWPARrNERIEXECUTIVE E.L. EACH ACCIDENT S E.L. DISEASE -EA EMPLOYE 5 OFFICL_RtMEMHER EXCLUDED? NNIA ❑ (Mandatory In NH) E.L. DISEASE- POLICY LIMIT $ IFgqos dasuibeunder DESL�RIPTION OF 0PE!2AT10N5 be'rnv C LIQUOR LIABILITY N N Lt_100697 01f0112018 0110112019 DC5CRIPTtON OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedala, may ba anechad If more space Is required) GERTtf IUA E-_ HOLULK k /Alll .r U_L 11v14 CITY OF SOUTH BEND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 125 S LAFAYETTE BLVD STE 100 THE EXPIRATION DATE THEREOF, NOTICF WILL BE DELIVERED IN SOUTH BEND, IN, 46601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ Fax: Email: O 1968-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks Of ACORD