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Client#: 34734 EXHIBIT G AMERSTR
<br />DATE (MMIDDIYYYY)
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE 10/16/2018
<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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER NAME: ChrlStOpher Ensminger
<br />ONI Risk Partners PHONE 3179594 FAX
<br />(AIC, No, Ext)-706-
<br />: ... (A/C.,,No). 317-706-9794
<br />600E 96th St Suite 400 E.MML
<br />ADDRESS, p 9 her.ensmin er@ christo onirisk.com
<br />Indianapolis, IN 46240 INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A t EdeiBomrsd r'Wra Imewrano'e wuf fY j 20478
<br />_. . ...,,,,,,,a... _mm� _, .,� , __. ,.....
<br />INSURED ..,,�,
<br />INSURER B The Continental l ran c p 35269
<br />American Structurepoint, Inc.
<br />_Ei "' 20427
<br />7260 Shad eland Station
<br />INSURER C A a Casualty co of Reading
<br />32603
<br />INSURER D :Barkley insurance Company
<br />Indianapolis, IN 46256
<br />--------- --- --
<br />INSURER E .
<br />INSURER F ;
<br />COVERAGES CERTIFICATE NUMBER:
<br />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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />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 />�... ....
<br />LTR ..,,....TYPE OF INSURANCE , ..... gR•ISA; Y ........... POLICY NUMBER
<br />-.. ......... ..... .. ......... .........
<br />( MIDDY EFL' PMlDOY'YY . ,........-,,,,,, ..
<br />MM1IFDDFYYYY) (MMFDD1yYYY) ..... ..... LIMITS
<br />A 'X COMMERCIAL GENERAL LIABILITY X X 6050367892
<br />1/01/2018 11/01/2019 EACHOCCURRENCE $1 OOO QOO
<br />CLAIMS -MADE ®OCCUR 1,
<br />R�
<br />DAMAET
<br />PREMISES�ERENTED
<br />aoacurrencz,) $1,000t000_
<br />MED EXP (An)/ one person) $15,000
<br />7
<br />PERSONAL &.ADV INJURY $1,,000,000
<br />GEN°L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />PRO- IryI
<br />POLICY Xq JECT q X , LOC
<br />PRODUCTS COMPIOPAGG $2,000,000,
<br />OTHER:
<br />$
<br />B AUTOMOBILE LIABILITY X X
<br />11/01/2018 11/01/2019 COMBINED SINGLE Owl-
<br />(R11opcwgnll $1,000,000
<br />�6050364572
<br />X ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS ii
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />... HIRED AUTOS .._...._.. AUTOS 1
<br />X..
<br />�
<br />PROPERTY DAMAGE $
<br />l .e± a¢, rle+m,(,).. .....- ........ _...,
<br />UMBRELLA LIAB
<br />B X UMBRELLAX X X 6050364555
<br />ACH OCCURRENCE $1
<br />11/01/20111 11/01/201 °AGGREGATE-°$l0�0Q0 000
<br />LIAe CLAIMS -MADE
<br />L
<br />0,000�000
<br />DED RETENTION $1 OOOO
<br />$
<br />WORKERS COMPENSATION
<br />C X 6050364569
<br />--- PER � �OTH
<br />11/011201811/011201 X STATf� E
<br />AND EMPLOYERS'
<br />ERS'LIABILITY Y...N I
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />EXCLUDED? N, NIA
<br />E L EACH AOCIDF.NT $1�000�000
<br />(Mandatory In NH)
<br />EL DISEASE EA EMPLOYEE $1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />,
<br />EL. DISEASE -POLICY LIMIT $1,000,000
<br />D Professional AEC902071102
<br />5/29/2018 05/29/2019 $5,000,000 Per Claim
<br />Liability
<br />$5,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Anyone person or organization, as required by written contract or
<br />agreement requiring insurance, is
<br />included as additional insured with respects to the General Liability and Automobile Liability policies.
<br />Coverage on the General Liability and Automobile policies is primary and non-contributory where required by
<br />written contract or agreement.
<br />A waiver of subrogation in favor of any person or organization, signed prior to a loss, as required by
<br />(See Attached Descriptions)
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />City of South Bend Department of THE SHOULD EXANY
<br />PIRATTIIONH DATE ABOVE THEREOF,, DESCRIBED NOTICEIES WIBLL CELLED BE CDELIVERED NE
<br />Public Works ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W. Jefferson Blvd. 13th
<br />Floor AUTHORIZED REPRESENTATIVE
<br />South Bend, IN 46601-0000
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S1711134/M1709569 CENSM
<br />
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