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LEPEE-1 <br />DATE (MMIDDIYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 05/02/2018 <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 />BELOWTHIS CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERiSI, AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE. CERTIFICATE HOLDER. <br />IMPORTANT. If the certificate holder Is an ADDITIONAL. INSURED, the policy(les) 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 Ileu of such endorsements . <br />PRODUCER 574-277-0234 Roy Sarson <br />HOLLAND INSURANCE GROUP PHONE $74.277-0234 FAX 574- "77.0286 <br />64081 N. Ironwood Rd., AIC Nq�Ert : AIo Na : <br />P.O'.. Box 6468 <br />South Bend, IN 46660-6458 <br />Ray Berson <br />._..__ IN uREaA: PROPERTY OWNERS 32905 <br />INSURED PEGGS of South Bond Inc. INSURER B: <br />Pe DaltonINSURERC: <br />12 S Michigan <br />South Bend, IN 46601 INSURER n <br />COVERAGES <br />OFREMEd�H <br />RANCE L <br />ISTED BELOW HAVE BEEN <br />ISSUED TO <br />THE INSURED <br />...... ........_ <br />NAMED ABOVE FOR THE POLICY PERIOD <br />THIS <br />IS TO.CERTIFYLICIES <br />T AT THE <br />I'N <br />M OR CONDITION OF ANY <br />CONTRACT <br />OR OTHER <br />DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE <br />MAY BE ISSUED OR MAY <br />PERTAIN, <br />INSURANCE AFFORDED ISY <br />THE POLICIES <br />DESCRIBE) <br />HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS <br />AND CONDITIONS OF SUCH <br />POLICIES. <br />ma, <br />Su <br />LIMITS SHOWN MAY (HAVE BEEN <br />NUMaER <br />REDUCED BY <br />POLGCY'E'FF <br />PAID CLAIMS. <br />POLIO <br />LIMITSTYPE <br />N R <br />OF INSURANCEPOLICY <br />A <br />X <br />COMMERCIAL GENERAL UAIN " <br />� 1,000,000 <br />CLAIMS-MAOE [X] OCCUR <br />Y <br />09026221 <br />06101/2018 <br />0610112019 <br />IaAM� EN��_ 300,000 <br />ED EXP IAnv one 10,000 <br />PERSONAL & AOV INJURY S 11000,000 i <br />LAGGR LIMIT AP I PER: <br />POLICY �II�T S <br />R 2.000,000' <br />MP1 P <br />2,000,000 <br />LOC <br />AUTOMOBILE LIABILITY <br />COMaq ED E NO E LI Y <br />r1fi'ti <br />ANY AUTO <br />AUTOS ONLY CUI%E ULEO <br />emad <br />BODILY INJURYc <br />' AUTOS ONLY AN4TO�� YI'ER <br />AMA" <br />UMBRELLA LIAB OCCUR <br />sail C URR ',N <br />S <br />EXCESS UAB CLAIMS-NWE <br />A <br />OED RETEN'nONS, <br />A <br />vw RKE C -MPE AT�oN <br />AI DI M o ERs°�AatL1TY <br />X r OTN- <br />YCPROPR�GRaPARr%IERIEX£CLNTIVE YIN <br />fp�BERPI,1 E�OLUrkEO�' � <br />� <br />N/A <br />09111406 <br />06/01/2018 <br />06/01/2019 <br />E.1.. <br />100,000 <br />em eloly n — <br />I a describe uridar <br />o . PE <br />10O,OOfI <br />RIM@..: <br />E.L. . I ISE'ASP -tint tC~••'Y l MIT <br />It 600,000. <br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requlmd) <br />City of South Bend Is Additional Insured on General Liability <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cityof South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY' PROVISIONS. <br />211 N Michigan Street <br />South Bend, IN 46601 AUTHORIZED REPRESENTATIVE <br />Ray Barron <br />w%;UKU Za lZU1t3rual 01988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />