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Client#: 34734 AMERSTR
<br />DATE (M�MIDDrrM)
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 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
<br />tAMG Christopher Ensminger
<br />ON] Risk Partners
<br />FAX
<br />"� E„yl 317 706-9594 AJC, Na : 317-706-9794
<br />JAiC,
<br />600 E 96th St Suite 400
<br />-.....
<br />E M 11 '
<br />ADDRess, christopher.ensmingeronirisk.com
<br />Indianapolis, IN 46240
<br />_
<br />INSURERS) AFFORDING COVERAGE NAIC #
<br />.. INSURER A: NaUonsl Ftre Insurance Co or H '20478
<br />INSURED^-..
<br />INSURER B : The Contineal insurance Camps _ ---'-� 35289
<br />American Structurepoint, Inc.
<br />...... ......
<br />INSURER American Casualty Co or Reading �20427
<br />7260 Shadeland Station
<br />32 Berkley _.........
<br />INSURERD: 603
<br />Indianapolis, IN 46266
<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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />�^..... �..... _..4DDLSUSR
<br />TYPE OF INSURANCE POLICY NUMBER
<br />P&IG:ILSfR LIMITS
<br />II-AW_.. Yrvt,L
<br />LIABILITY X XDD
<br />6050367892
<br />A X COMMERCIACLAIMSL
<br />11101/2018 11/01/201
<br />URRNCEEOCR
<br />MADE
<br />.E C$1,000 000 �
<br />nae
<br />�
<br />MED EXP (Any oneperson) S15,000
<br />PERSONAL &ADV INJURY $1 000 000
<br />GEN'LAGGREAPPLIES
<br />GENERAL AGGREGATEs2,000,000
<br />,�7X
<br />JECTLOC
<br />PRODTSCOMP/OPAGPOLICY 2a000000
<br />OTHER:
<br />$
<br />-
<br />AUTOMOBILE LIABILITY -
<br />B X X 605036457 2
<br />- -
<br />11/0112018 11l01l201 COy1SINESgNGLELIMlT 1,000,000
<br />x ANYAUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />X HIREDAUTOS X ''.AUTOS
<br />BODILY INJURY (Per accidennt)i) $
<br />PROPERTY DAMA4,E M
<br />Peiacirdent4 �$
<br />1$
<br />�... ............. „,,,.., ,�.,..,..,.,.,.. . .,_,_,_,
<br />...B X UMBRELLA LIAB X..-
<br />OCCUR X X 6050364555
<br />11/0112018 11/01/201 EACH OCCURRENCE $10 000 000
<br />EXCESS LIAB CLAIMS•MADE
<br />AGGREGATE $1 O 000,,000
<br />DEC) X RETENTION $10000 1
<br />S
<br />—r6TH-
<br />_.. -
<br />C WORKERS COMPENSATION X 6050364569
<br />PER
<br />11/01/2018 11/01/201 X
<br />,ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIE TVPARTNER/'XECUTIVE�
<br />OFFIICERIMEM 'R EXOtUDED7 N NIA
<br />EACH ACCIDENT $11 000,000
<br />(Mandatary in NH)
<br />E.L.. DISEASE . EA EMPLOYEE. $1 000 000
<br />dt:sdbo under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L.DISEASE -POLICY MIT $1 OOO OOO
<br />_ r
<br />,,11yes,
<br />D Professional AEC902071102
<br />5129/2018 05129/2019 $5,000,000 Per Claim
<br />Liability
<br />$5,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
<br />Anyone person or organization, as required by written contract or 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 />I1r1 of South Bend Department of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<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 />01988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S1711134/M1709569 CENSM
<br />
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