Laserfiche WebLink
ACC11RE0 CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM7bkd1YYVY) <br />1 a12B12016 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER., THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE, CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <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 ri hts to the certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />StateFarM TIMI KELLY <br />'902 E IRE.LAND RD <br />" SOUTH BEND IN' 46614 <br />TACT TIM KELLY <br />NAME: <br />PHONE 574-291-6111 c Na : 674-291-7767 <br />E MAIL <br />INSUREE1§1 AFFORDING COVERAGE <br />NAIL # <br />INSURERA: State Farm Fire and Casualty Company <br />26143 <br />INSURED <br />DONALD R LINDEN TRUST DBAAVANT] MUSEUMGROUP <br />900 THOMAS ST <br />SOUTH BEND IN 46601 <br />INSURER B : <br />INSURERC: <br />INSURER D : <br />1 INSURERE: <br />INSURER F' <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES iDESCRIBED 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />immmylywn <br />POLICY EXP <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X <br />94BBQ035 <br />09108/2018 <br />09/08/2019 <br />EACH OCCURRENCE <br />5 2,000,000 <br />TO RENTEb <br />PEES, (Ea occurrence) <br />$ 300,000 <br />MED EXP y one.person) <br />$ 5,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY .PRO. 1:1 lOC <br />OTHER: <br />PERSONAL &ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />S 4,000„000 <br />PRODUCTS-COMP/OPAGG <br />$ 4.000,000 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON.OWNED <br />AUTOS ONLY AUTOS ONLY <br />(EaCOMBINED accident) GLELIMIT <br />BODILY INJURY (Per person) <br />S _ <br />BODILY INJURY (Per aWdent) <br />$ <br />PROPERTY DAMAGE <br />Per ace idea <br />$ <br />i$ <br />UMBRELLA LIAB <br />EXCESS LIAR <br />OCCUR <br />EACHOCC'URRENCE <br />$ <br />HCLAIMS-MADE <br />AGGREGATE <br />$ <br />DED RETENTIONS <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE Y� <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />II yes, descn'be under <br />DESCRIPTION OF OPERATIONS b0ow <br />NIA <br />! <br />PTAR.TUTE eft <br />E,L. EACH ACCIDENT <br />S <br />E,L DISEASE - EA EMPLOYE <br />$ <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 11If, Additional Remarks Schedml'e, may be attached If more space Is required) <br />III <br />CITY OF SOUTH BEND <br />PUBLIC WORKS <br />227 W JEFFERSON SUITE 1316 <br />SOUTH BEND, IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WWITH THE POLICY PROVISIONS. <br />AUTHORIZED <br />1�I 'I Md'J'tl^aCW"1 xiA4:J'RLA I+LA="GI�`VR64.IIVI„1„ M11 I1�'114+"a IG.?Gi'MF41„. <br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD <br />10014e6 tszsas.tz 03-16-2016 <br />