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CERTIFICATE OF LIABILITY INSURANCE °ATE,MM,°DIYYYY)
<br />03115/2019
<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 endorsements .
<br />PRODUCER ACT
<br />w,O T
<br />... House
<br />Salinas Insurance Agency Inc
<br />2938 S Main St
<br />NAIC #
<br />Elkhart IN 46517 INSURERA: ERIE INSURANCE
<br />INSURED INSURER B : 100 ERIE PL
<br />...................................................................................................................
<br />SOUTH BEND BREW WERKS INSURER : ERIE, PA 16530
<br />216 S MICHIGAN ST INSURER
<br />SOUTH BEND, IN 46601 INSURER E:
<br />rnVE'RAr.r- CERTIFICATE NUMBER- REVISION NLIMRER-
<br />THIS
<br />IS TO CERTIFY THAT THE POLICIES OF
<br />INSURANCE
<br />LISTED BELOW HAVE BEEN
<br />ISSUED TO
<br />THE INSURED
<br />NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION OF ANY
<br />CONTRACT
<br />OR OTHER
<br />DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE
<br />MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFFORDED BY
<br />THE POLICIES
<br />DESCRIBED
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS
<br />AND CONDITIONS OF SUCH POLICIES.
<br />LIMITS SHOWN MAY HAVE BEEN
<br />REDUCED BY
<br />PAID CLAIMS,
<br />INSR.....
<br />-- - ,.....
<br />.......,, __— AWL
<br />SUhR
<br />�. ...,.
<br />POLICY FF
<br />POLICY
<br />.....������..
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />immontyyyyl
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />❑
<br />Lir��U err .... _ ...........
<br />1,000,000
<br />., CLAIMS -MADE OCCUR
<br />F �c�,larrFnre $
<br />PREMISE(P _ j�, ..... ,,,,,— _
<br />..............._ ........
<br />MED EXP (Any one person) $ 5,000 ............................................—
<br />A
<br />m . Y
<br />N
<br />Q46-0155422
<br />10/01/2018
<br />10/01/2019
<br />PERSONAL&ADV INJURv...................... ,000,000
<br />_..
<br />GEN'LAGGREGATE LIMITAPPLIES PER
<br />GENERAL AGGREGATE $ 2,000,000
<br />- LOC
<br />POLICY pE�T _
<br />PRODUCFS.COMP/OPAGG $ 2000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />f OM0INt D ^ INOt E LI101 f $
<br />na. , ..... .......... _. ...... ........
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />OWNED SCHEDULED
<br />...................................................................................................................................----------------
<br />BODILY INJURY (Per accident) $
<br />AUTOS ONLY AUTOS
<br />__._.___________
<br />HIRED NON -OWNED
<br />PROPERTY DAMAT�u I. $
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LIAR OCCUR
<br />HCLAIMS-MADE
<br />EACH OCCURRENCE
<br />$
<br />EXCESS LIAR
<br />AGGREGATE
<br />$
<br />DFD RETENTION
<br />$
<br />WORKERS COMPENSATION
<br />PER OT"H-
<br />AND EMPLOYERS' LIABILITY YIN
<br />ST,AT„L.IT,F................R.......................................,..,,,,,,
<br />—
<br />ANY PRO PRIETORIPARTIN EXECUTIVE ( )
<br />EACHACCIDENT
<br />$.......�
<br />OFFICERfMEMBER EXCLUDED? j
<br />OFFICERIME BER EXCLUDED?
<br />N /A
<br />_ ... .....
<br />.J
<br />(Mandatory '
<br />EMPLOYEE
<br />E,L, E
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E L DISEASE - POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />CITY OF SOUTH BEND
<br />227 WJEFFERSON BLVD
<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 />fA
<br />X:
<br />ACORD 25 (2016/03)
<br />A 19RR_2015 ACORD CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />
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