|
0 DATE (MM/DDNYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />09/24/2018
<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 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 endorsemerl
<br />PRODUCER CONTACT Susan Thompson
<br />NAME�
<br />Laven Insurance Agency Inc, Fet uPHONE 1pl(574) 291-5510 (574) 291 8505
<br />JkMa—_-_ I
<br />P. O. Box 2379 E�MAIL..,
<br />lhho� suet@laveninsurance.com
<br />11111ill!=Iffill
<br />llaoffla=
<br />Fiddler's Hearth, Inc,, DBA: Fiddler's Hearth
<br />Ceol Mor, Inc,
<br />127 N. Mein Street
<br />South Bend IN 46601
<br />COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 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 13 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />-'ADM Mm1t ........ ..... _06CE(dCry"E'r�F_ POUCYCXP
<br />LTR_ TYPE OF INSURANCE INSD WVD POLICYNUMBERmmm MMID LIMITS
<br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
<br />UXUAZ 500,000
<br />CLAIMS41AADE OCCUR PRE&USES
<br />MED EXR (Any one a n) $ 5,000
<br />A Y 6605292 09/18/2018 09/18/2019 PERSONAL.&ADV INJURY $ 1,000,000
<br />1, AGOFWGfVI'E LIMI 11 APPLIES PER I ��_NF -AGGREGATE S 2,000,000
<br />.............................................. . ......... . . . . . .. .. ........... . 11111111 ............ . . . ................ . . . . .
<br />> I 10'I 10Y, LOC PRODUCTS COMP/OPAGG S 2,000,000
<br />I ..... . . ....... . . .. ......
<br />[OTHER:
<br />............ ......... ..
<br />AUTOMOBILE LIABILITY COMBINED SINGLE. k..imirr $ 1.0000,000
<br />....................... . . . ......... . . . . ...
<br />ANYAL)TO BODILY INJURY (Per c-son) S
<br />A OWNED SCHEDULED 6605291 09/18/201 B 09/18/2019 BODILY —INJURY (Per acrident")""'S ............
<br />AUTOS ONLY AUTOS
<br />HIRED -,�e NON OWNED
<br />AUTOS ONLY AUTOS ONLY Fla
<br />. . . . .. . ............... .............. ................................... . . - — ---------- ... .... ... -------0- -
<br />5,00,
<br />UMBR E� OCCUR EACH OCCURRENCE IS 000
<br />A EXCESS 11"f-L�LN!�21M9EL 6605292 09/18/2018 09/1812019 AGGREGAIE 5,000,000
<br />AND EMPL..OYFRS li.(AB(L.f10,000
<br />------ --------- - --- - -- . ..... . . . . . ................................
<br />WORKERS
<br />COMPE ATZw >�J ST k pr—TTUiFEU
<br />RZFE
<br />AND EMPLOYERS'LIABELITY YIN ---
<br />A ANY FROPIV RIETORIPARTNERIEXECUTE [ ACC DI NI $ 500,000
<br />OFFICER/MEMBER EXCLUDED? NIA 6605290 09/18/2018 09/18/2019
<br />(Mandatory in NH) E L. DISEASE - EA EMPLOYEE S 500,000
<br />11 yes, describoundcr
<br />I F OPERATIONS blaw F L DISEAIE POLI 500,()00
<br />CY LIMIT
<br />. . . . . . . . ........... . ........
<br />Liquor Liability Occurrence I imit $1,000,000
<br />A 6605292 09/18/2018 09/18/20I 9 Aggregate I irnit $2,000,000
<br />...... . . ........................ ............................ . . . ........ ...... . . . . . . .... — — — — ....................... . ............. 1.11111- ------------------- --------------------------------------------------
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Location: 127 IN Main Street, South Bend, IN 46601
<br />- - - - ----- ------------- __--- -- ----
<br />IN
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of SOLIth Bend ACCORDANCE WITH THE POLICY PROVISIONS.
<br />125 S. I afayette Blvd,
<br />AUTHORIZED REPRESENTATIVE
<br />Suite 100
<br />South Bend IN 46601
<br />1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are regigtered marks of ACORD
<br />
|