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MI-ASER-01 _M910MA
<br />ACORD DATE (MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 02I1812019
<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 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 rights to the certificate holder in lieu of such endorsement(s),
<br />PRODUCER
<br />Lockhart
<br />y _._. .„ EMI: „ I-,,,,, .
<br />3900 Kinross nLakes Parkway #300nchise Division PHONE
<br />T Cl(4 ) 895 6527 AX,Neg 4d0 356 2126
<br />License 954553 ......... AC
<br />Richfield, OH 44286 R06, cindy.lockhart@AssuredPartners.com
<br />--� INSURER Sentinel Insurance Co Ltd „-.e... 11000
<br />m
<br />INSURED INSURERB, Hartford Underwriters Ins Co 30104
<br />.....,,,..
<br />MI-ALD Services LLC dba American Leak Detection INSURERC:
<br />PO Box 2073 _mm �..........
<br />INSURER D
<br />Portage, MI 49081
<br />INSURER E
<br />............................... _w. .......,.,. ._........... m_INSURER F
<br />._W._..___,�.....:......... ...,.............
<br />._... „_.......... .........
<br />COVERAGES ..... CERTIFICATE NUMBER ...........................
<br />..... ....w_.. ....... REVISION NUMBER ........ w
<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 />A COMMERCIAL GENERAL LIABILITY T TYPE OF INSURANCE ADOL UBR POLICY EFF POLICY EXP LIMITS
<br />SR m.................m, BILITY J16� F� . .... „POLICY NUMBER �..LI,R dl�dl7(
<br />EACH OCCURRENCE $ 2,000,000.....
<br />-..... _ ....
<br />CLAIMS -MADE X occuR 45SBANU4997 04103/2018 0410312019DMAGE TO RENTED—
<br />yiR9,5,(F,nrrence�
<br />MED EXP (,Any one.person) $ 10,000
<br />PERSONAL & ADV INJURY $
<br />2,000,000
<br />GfNdLAGGREGATE; LIMIT APPLIES PER: GENERAL AGGREGATE „ $ ,
<br />X 000,000
<br />POLICY . J`OT LOC 4 000000
<br />PRODUCTS - COMPIOP AGG $
<br />A "AU O�6f OIL ,.�.,.----....... ..... ......--- COMBINED SINGLE LIMIT .� 1 0.,
<br />AUTOMOBILE LIABILITY OO,000
<br />LEat Igc4ad�f�Tt _ �,,,,
<br />X OWNED ONLY AUTOSULED ANY AUTO I SUECZK3444 0410312018 04/0312019 BODILY INJURY (Per person) $
<br />X ODILY J Y Per acc dent) $
<br />______
<br />AUXNONOONED I'll AMACC
<br />TOS N$
<br />T_ _.._.......... _...-.... _._ .�. ........s $
<br />UMBRELLA LIAB OCCUR EAACH OCCURRENCE $
<br />EXCESS LIAB CLAIMS MADE AGGREGATE
<br />$
<br />�.... ,.- DED (...... I.. RETENTION $ ...... ..
<br />13 WORKERS / I ..w....wm... ......-.. .....n,e,...�-, „-.m,...,,�...-._. ... ...........mw,.,.. E1: EACH.._.... T $
<br />ANY PRRO RIETOR'LIABILpJTY YIN � .. .. ,..,.,TACCIDEN ILR����„$,,, ...... _ .
<br />AND EMPLOYERS'
<br />PRIETORIPARTNER/EXECUTIVE 45WECBV7412 0410312018 0410312019 100,000
<br />FPI ERNfmhPM R EXCLUDED? N I A
<br />.¢Ivan ate In
<br />If es, describe under E L. DISEASE - EA EMPLOYEE'` $ 1 OO,000
<br />y ....OFF OPERATIONS below�� ._. E L_DISEASE - POLICY LIMIT $ SOO,000
<br />DESCRIPTION
<br />City RISouth Bend is Additional Insured for the above listed General a*a Schedule, re space
<br />...............ww mm.....___W ..�v.w
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 107, Additional Y�e%m puler, maybe attached fr mna�a space 6a required)
<br />Liability policy with regards to the operations of the named insured.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />915 S. Olive Street
<br />South Bend, IN 46619 ._.._........._..........._......... 6
<br />AUTHORIZED REPRESENTATIVE
<br />_ ... ..... ........... .........
<br />ACORD 25 (2016/03) O 1988-2015 A
<br />c CORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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