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A <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MM1 019YY) <br />—THIS' RiIFICATE IS 04/082019 <br />BELOW. CERTIFICATE THIDOCERTIFICATE ISSUED AS A OTAFFIRMATIVELY <br />F INSURANR OF INFORMATION ONLY AND CE CONFERS <br />CER D EGATI ELY AMEND, EXTE DOR ALT R RIGHTS <br />UPON THE CERTIFICATE HOLDER. THIS <br />HE COVERAGE AFFORDED BY THE POLICIES <br />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 pollcy(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 r7 'tl'AC1' <br />INSURED <br />Eric Guenther, Agent <br />411 E Ireland Rd Suite 100 <br />South Bend, IN 46614 <br />J Weldy LLC <br />131 S Michigan St. <br />South Bend, IN 46601 <br />Mandy Newton <br />574-291-1597 <br />tNsIM901w:ORVlnG F9w FmsE <br />UREA A! State Farm Fire and Casualty Company <br />D: <br />E: <br />574-291-1632 <br />NAIL A. <br />25143 <br />-. ..._. REVISION <br />COVERAGES <br />CERTIWITHSTANDING ANY ES OF INSU NUMB ISTED BELOW HAVE BEEN ISSUED TO THE .__NUMBER: <br />ABOVE FRS <br />CERTIFICATE ER: N N MBE _ <br />�FY RANCE INSURED NAMED OR illiE POLICY PERIOD <br />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 IS SUBJECT TO ALL THE TERMS, <br />AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TRXC......TYPE <br />.�n , m�....... <br />EXCLUSIONS A D T <br />Nbn ...., �M�L11* Yyy Pgt;gIGYrXP � 1kLp�tlC..C: ..1..__,.....__.., _.,. <br />_.... . ._ ... N5 <br />PE OF INSURANCE POLICY NUMBER Y dt"IOFYYY LIMITS <br />COMMERCIAL GENERAL LIABILITY Cr'MIeIb d'JL.CUd• ,000,000 <br />CLA(MSMADE I �OC:CUR tlMf-A6CT P'E"ATt"0 m m... <br />MFLI�V S ts'8�ttllPaurFN.. <br />1 000 000 <br />.. ....... ..__ ... _D e RP rn� cr�an yaoawmro) � � 5,0011 <br />Y _ ••�.- -�.k 94-BS-T627-9 08/01120111 08101/2019 ICOA�AuvtNruRY T 2�000,000 <br />GENERAL00 000cEN°LAGCRryATL IMIrA RUES Pf,._P: <br />POLICY LOC <br />PRODK 6 LMIAG <br />s 2,000,000 <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED V ,CHEDUI. ED <br />AUTOS ONLY AUTOS <br />HIRED NON OWNED <br />. AU1 OS ONLY AUTOS ONLY <br />UMBRELLA LIAB OCCUR <br />EXCESS LIAR CLAIM MADE E <br />... ,p U lar 1 F N"C .. .�. <br />- VEIN a <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />4 Yr'6�1Ls MI% EV« AFR P.XCLUDED7 ❑ �N/A <br />(Manainlory in NH) <br />If o% dv. mn lln+a under <br />$ <br />C�47N16MC'-.SlNC" LI I,.NWgatB'9' <br />) BODILYpIhNJI -,.- ...--- -- INJURY (Per person) $ <br />BODILY INJURY (Per aucldent) $ <br />i eu c'E cI Y I.IdzM%FF <br />t.T-- L°PI <br />I.LY)i — <br />$ <br />EACH 4"XX RJ'HHFr�i P� <br />GGREGATE <br />E.L EACH ACCIDENT $ <br />EL DISEASE - EA CMPkL0"YL"I^( f5 <br />C` i,- DISEASE - POLICY LIMIT I $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more <br />ore space is required) <br />Pizza Restaurant <br />CERTIFICATE HOLD <br />City of South Bend Indiana <br />227 W Jefferson Blvd <br />South Bend, IN 46601 <br />ACORD 25 (2016103) <br />TION <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 />© 1988-2015 ACORD CORPORA l* •All rights reserved <br />The ACORD name and logo are registered marks of ACORD <br />1001486 132849.12 03-1rr2016 <br />