Sidewalk Cafe - Nom Nom Pho Asian Kitchen

Home Browse Search

AC61?hP CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDnrYYY) 04M3/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTAC NAME:. Gerald N Stark American Family Brokerage Inc PHONE FA 847 394-3220 aac No) 6000 American Parkway ADDRESS. gstark2arnfam.com, INSURERS AFFORDING COVERAGE NAIC # INSURERA: USLI - United States Liability Insurance Madison WI 53783 INSURED INSURER B r INSURER C : Nom Nom Pho Asian Kitchen Sapkota Brothers LLC DBA INSURER D : 2111 North main St. INSURER E : South Bend IN 46601 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO yWVD POLICY NUMBER MMIDD MM/L7OPA") LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE .00CUR EACH OCCURRENCEDAMMET arc PREMISES Eaoccurrence) $ 1.000A00 $ 100,000 MEDEXP(Any one arson) _ $ 5,000 PERSONAL dADVINJURY $ 1,000,000 A X CP2621764 08/01/2018 08/01/2019 GENT. x AGGREGATE LIMITAPPLIES PER: POLICY PE® LOC GENERAL AGGREGATE PRODUCTS - COMP/OPAGG $ 2,000,000 2.000,000 $ OTHER.:. AUTOMOBILE LIABILITY COMBINED SINGLE UMI"f $ ''. ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PFdOPER1'YDAMAGE. P' r 8 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ 'WORKERS COMPENSATION PER ER AND EMPLOYERS' LIABILITY Y d N ", ..'.„,•, "OTH- " " E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N / A - EA EMPLOYEE $ (Mandatory in NH)DISEASE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Commercial Property Coverage Business Personal Property - Coinsurance 80% Deductible: $2,500 Limit: $100,000 Equipment Breakdown Deductible: $1,000 Limit: Included City of South Bend is an additional insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jeffereson Blvd Ste 1316 AUTHORIZED REPRESENTATIVE South Bend IN 46601 _4 ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD