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-- EPOCH-1 OP ID: CH
<br />DATE (MM/DDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 05/08/2018
<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 CONTACT
<br />R.S. Miller &Sons, Inc. NAME: Gregory S Mlller, CPCU,CIC
<br />P.O. Box 229 �Arq, q, laxll, 574-546 3341 FAX
<br />574-546 2687
<br />109 W. Plymouth Street E-MAIL
<br />Bremen, IN 46506 ADDRESS:
<br />Gregory S. Miller, CPCU,CIC _ INSURERS) AFFOR_DIN_G COVERAGE NAIC #
<br />INSURER A: Liberty Mutual Insurance Co. 24082
<br />INSURED EpochArchltecture+Planning LLC INSURER B : Liberty International Underwrl 24082
<br />Kyle Copelin ....... ®..._...
<br />300 W. Jefferson Blvd. INSURER c : Pekin Insurance Company 24228
<br />South Bend, IN 46601 INSURER D t „
<br />INSURER E :
<br />INSURER F : ...... ......... ...... ....
<br />UUVtKAUt, GtKlll IGAIt IVUMMLK: KtVIJIUN II' U➢VIC1tK:
<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 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 />INSR ....TYPE OF INSURANCE ADDL � alk .... Ot ICY EFF` 1 POLICY EXP LIMITS
<br />........_ ........._ ...
<br />LTR N WV. POLICY NUMBER MMRPNY'YY TI MM11DDgXyY _.w.I...____..
<br />A I ,X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00(
<br />CLAIMS -MADE X occuR BZS 57342600 06/27/2017 06127I2019 DNMAGETORENTED
<br />PREMISE „� ocou rence),,, $ 1,000,00(
<br />MED EXP (Any one person)
<br />$ 15,00(
<br />RY
<br />INCLUDE[
<br />®
<br />GEN°L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2000 00(
<br />P;C,g Cr.
<br />t POLICY J,1:1LOC
<br />,
<br />PRODUCTS - COMP/OP AGG
<br />... ..
<br />$ 2,000,001
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />I
<br />1_00985MED SIN?5LE LIMIT
<br />(EA aceidenl}
<br />1,000,00 (
<br />A {I ANY AUTO
<br />BZS 57342600
<br />06/2712017
<br />06/27/2019
<br />BODILY, INJURY (Per person)
<br />$
<br />ti
<br />I I ALL OWNED SCHEDULED
<br />� AUTOS _...... AUTOS
<br />� BODILY INJURY (Per accident)
<br />$
<br />X X NON OWNED
<br />PROPERTY DAMAGE
<br />$
<br />HIRED AUTOS
<br />.......... AUTOS
<br />(Per accident)
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE
<br />$
<br />C j EXCESS LIAB
<br />CLAIMS MADE
<br />AGGREGATE
<br />$
<br />DED I RETENTION$
<br />I
<br />$
<br />ANY
<br />PROFFICEOPRIE OR MEMBER EXCLUDED? MPLOYERS' LIABILITY v NIA �WC0004690C 02106/2018 02/O6/2019 '.E , EACH
<br />C ANY PROPRIETOR/PARTNER/EXECUTIVE I LEACH ACCIDENT $
<br />(Ma
<br />ry
<br />' L, DISEASE - EA EMPLOYEE $
<br />If yes, describe under m- ----------,,.. ,. ............,,,,,,
<br />DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT $
<br />B Professional Liabi 05312016 06/10/2017 06/10/2019 ($5,000 Ded Ann Aggr 2,
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<br />AGRAIND
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Gregory S. Miller, CPCU,CIC
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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