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,.•�0 ......DATE (MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />04/04/2019
<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 endorsement(s).
<br />PRODUCER CONTACT Susan Thompson
<br />NAME-
<br />Laven Insurance Agency, Inc. PIIONC (574) 291-5510 FAX (574) 291 8505
<br />P. O. Box 2379 &rn o suet@laveninsurance.com
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />SOUTH BEND IN 46680 INSURERA: Frankenmuth Mutual Ins, Co, 13986
<br />.. ............
<br />INSURED
<br />INSURER B
<br />fa(Jastrie, LLC INSURER C
<br />...INSURER.�®.�..............................................................................�.................................................
<br />103 W, Colfax Avenue
<br />South Bend IN 46601
<br />1 INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 18-19 Master
<br />REVISION NUMBER:
<br />THIS IS TO CER FIFY THAT THE POLICIES OF INSURANCE:. LISTED BELOW HAVE BEEN ISSUED TO FHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PE-RTAIN, FHE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br />-TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />_
<br />EF EXP
<br />POLICY........ FPOLICV
<br />A�SD
<br />'....�
<br />LTR SURANCE POLICYNUMBER MMDD
<br />LTR. TYPE OF IN „. MMIDDIYYYY)
<br />„ INSD V�A/O ...... .. ...... ....
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />s 1,000,000
<br />HUXG"°FTL}1 N11^f'
<br />50o 000
<br />w,a........a.e........, CLAIMS -MADE
<br />REMISE (Fa„(Yt'rtfrrF nre)
<br />1
<br />s
<br />MED EXP (Arty nne person)
<br />5,000
<br />A Y 6606602 10/16/2018 10/16/2019
<br />.....
<br />PERSONAL &ADVINJURY
<br />$�1,000,000
<br />LJAr[!r; IMITAPPIES PER
<br />:
<br />.���
<br />GENERA.AGGREGATE
<br />.....��......�
<br />aAFE 2,0aa,0O0 .�
<br />..
<br />twi3'fu9..
<br />�)
<br />.,-..,,...,.�,
<br />2,000,000
<br />.�. POLICY ECT OC
<br />PRODUCTS COMPA)PAG
<br />,r
<br />OTHER.
<br />,,,,,,,,,,,,m
<br />AUTOMOBILE LIABILITY
<br />9 d:�7tti' MNED SINDi t V.IMIJ
<br />$ 1,000,000
<br />.
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />A OWNEC3 SCHEDULED6606601 10/16/2018 10/16/2019
<br />e.� ._..._.
<br />BODILY INJURY (Per accident)
<br />...,.
<br />C
<br />AUTOS ONLY AUTOS
<br />HIRED 11 '. NON -OWNED
<br />PF20PFR'4Y DAMAGE
<br />AU TOE ONLY _u.. AUTOS ONLY
<br />(Per ,idFetn
<br />... -. _ .
<br />x UM,.1
<br />BRELLL A LIAB X
<br />5,()00000
<br />OCCUR
<br />EACH OCCURRENCE
<br />�,
<br />Excess A.LI......
<br />A ssosso2 a116/2018 1 ar16...
<br />CLAIMS MADE 2019
<br />Ar C FEE C AI F
<br />5,000,OOa
<br />.. �
<br />RF1"FN:TION a 0
<br />-0 _..,,,_. ......
<br />WORKERS.
<br />_
<br />AND t-NIP"I OYERS" F.GABEV..BfY
<br />'LIABIN
<br />X s( Jmt�IF Fri
<br />YE ULO
<br />RrExEcuTEVP Y NIa 6606600
<br />A OF IEXCLUDED? 1a(16/2018 10116
<br />FICEIIin L. /2019
<br />,L. EACH ACCIDENT
<br />_
<br />Cy00 a00
<br />b
<br />in NH)
<br />NH)
<br />E,L. DISEASE - EA EMPLOYEE
<br />S 500,000
<br />If yes, descrihe under
<br />.....m m,.�.,..,..,m.,..___,,,,
<br />,..._,�.�.a......_. ...._..._
<br />500,000
<br />DESCRIPTION OF OPERATIONS below
<br />El DISEASE - POLICY LIMIT
<br />g
<br />..................... ..................... ES (ACORD 101 Additional Remarks Schedule, may be attached if more space is req
<br />)VEHICLES
<br />uired
<br />Location 103 W. Colfax Avenue, South Bend, IN 46601
<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 South 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 registered marks of ACORD
<br />
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