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Client#: 61560 AZULHOS
<br />ACORD.CERTIFICATE OF LIABILITY INSURANCE D03/2712019Y
<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 />IfORT T:Rifie certificate
<br />SUBROGATION IS WAIVED, sulbtect to thetermsand LcondittiionDs of the posy certain tpolicies DDmalyO require an endorsement A statement
<br />on
<br />t on
<br />this certificate does not confer any rights to the certificate holder in lieu of such endorsesDent(s),
<br />PRODUCER =Felr
<br />'C Onn Is J. Messer
<br />ONI Risk Partners (gHnw Emwp 574-314-9190 C�go). 866-893-4638
<br />100 East Wayne Street, Ste 315 E MAIL
<br />South Bend, IN 46601 AooIFe3$,;' connie.tnesserL?onlrisk.corn
<br />INSURER(S) AFFORDING COVERAGE NAIC //
<br />INSURER A: Zurich Insurance Company Limited
<br />Ni_ R, _... _. ... �m ura ..-P Y ., ..
<br />IURED 5289
<br />Azul Hospitality -Indianapolis, LLC INSURERS: The Continental Insurance Company 3
<br />INSURER C :
<br />Azul Hospitality -Services, LLC - —
<br />800 W. Ivy St. Suite D INSURERD:
<br />San Diego, CA 92101 INSURER E
<br />„
<br />- INSURER F ;
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />iNSR — ...ADOtl„$�NFCI& .. P?L1Ctirh*FF POLf+,""Y XP �...,,,,,,,
<br />LTR TYPE OF INSURANCE I POLICY NUMBER M{'ddiD )
<br />.... ii^I {,� .............. .._. �, .,,,n , f31YY'Y A"I IkpAuNNud'O�kdY MY ,. LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY X CP0106375701 9/15/2018 0911512019 EACHOCCURRENCE$1�000,000
<br />I
<br />CLAIMS -MADE -`� OCCUR PRE,RENT"" ° ISE a•opnce $1 000 000
<br />DAM. -MES7� ). .. ,. .....�.r„
<br />MED EXP (Any one person) $10,000
<br />PERSONAL$ ADV INJURY $1,000,,000
<br />GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br />POLICY JECOT X LOC pH TS COMP/OPAGG $2 000,000
<br />OTHER: $
<br />A AUTOMOBILE LIABILITY CP01 06375701 9/15/2018 09115/201FOnMsR� INGLE LIMIT $1 000 000
<br />ANY AUTO BODILY INJURY (Per person) $
<br />... AUTOS ONLY AUTOS BODILY INJURY (Par "c �
<br />OWNED SCHEDULED raccident) $
<br />NON -OWNED 046P ddenl ._... _ _..
<br />HIRED ERTY UIIMJ/1CaE
<br />AUTOS ONLY X AUTOS ONLY tP2f a ) $
<br />B X UMBRELLA LIAB EXCESS LIABCLAIMS-MADE AGGREGATE $5
<br />,Q0
<br />X OCCUR 6050530380 9/15/2018 09/15/201 EACH OCCURRENCE $50,00000,,000
<br />,000
<br />X RETENTION $10000 $
<br />— .®,,,, __ -m `PER
<br />WORKERS COMPENSATION ' "
<br />AND EMPLOYERS" LIABILITY Y / N SSP:TL!T,F . .� �OTH-
<br />ER,
<br />ANY PPiOP IdwNh.'I' rVf A9i'tNE~14JGEXECUTIVE E L. EACH ACCIDENT $
<br />OrFo4TIT,MEFd8FREXCLUDED? N/A _ .
<br />imondnlory In NH}
<br />If yes, descrihe under E.L DISEASE - EA EMPLOYEE $
<br />DESCRIPTION OF OPERATIONS below EL .
<br />L. DISEASE - POLICY LIMIT $
<br />A Liquor Liability CP0106375701 9115/2018 09/15/201 $1Mil 0CC/$2 Mil Agg
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
<br />The City of South Bend is additional insured to the general liability policy when required by written
<br />contract.
<br />Lac# 1 - 111 N. Main Street; South Bend, IN
<br />Building # 1 Hotel d
<br />n m Q4, r
<br />o
<br />CERTIFICATE HOLDER CANCELLATION �b
<br />SHOULD ANY OF THE ABOVE DESCRIB I
<br />City Of South Bend THE EXPIRATION DATE THEREOF NOT I �BE DELIVERED IN
<br />BEFORE
<br />kr
<br />227 W. Jefferson Blvd Ste, 1316 ACCORDANCE WITH THE POLICY IPROVIFrtON �'")` L
<br />South Bend, IN 46601
<br />AUTHORIZED REPRESENTATIVE'
<br />©1988-2015 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S1930790/M1930789 CMESS
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