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""' DATE TE(MMIDD/YYYY) <br />C .- CERTIFICATE OF LIABILITY INSURANCE F04/29/2019 <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 endorsementfsl. <br />;.UV'1 KA1ot5 C:tK I IFIUA It NUMUtil: KEVISION NUMEIER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />IN SR ................... AODIL�50.lf�R POLICY.NUM-- R------ ...,POLICYEFF .-------- ..-..-.- __...................................... <br />uEL TYPE OF INSURANCE F POLh�YEXP LIMITS <br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br />i57CIAT J t(} (('"rr it I --- --------- <br />CI_AoM5 MADIF �..X..� OCcuR Pagputl S Ea gc$wirrpJ,cPti $ 250000 <br />....... <br />.. ......... ------- -.-....... <br />.- <br />MEIu E)t6 dFBuiyr one person) <br />----- ---------------- <br />$000., ......... .................. <br />A <br />_ <br />N <br />N <br />BP34927 <br />03/28/2019 <br />03/28/2020 <br />PLRS0NAL & ADV INJURY <br />.. ......... <br />-.hyENE.V2 <br />$ 1000000 <br />... ......--- <br />f.3F ITT. <br />AGOREf ATE LIMIT APPI IFS PF R. <br />Ptl. AGGREGATE <br />$ 2000000 <br />XLIP <br />IPRO.... t..DC. <br />PRODUCTS-COMFIOF AOt; <br />7i <br />$ 2000000 <br />F: Ft: ............ <br />AUTOMOBILE <br />.. <br />LIABILITY <br />._ <br />C,WIPVNF0'S1 of LF 4.pklit <br />,Ihp,rLr. �r3+ArvY.t,.............. <br />$ 1000000 <br />......... .____... <br />ANY AUTO <br />BODILY INJURY (Per person) <br />:$ <br />B <br />OWNED SCHEDULED..._. <br />E6l1LSCHEDULED— <br />OAUI WE C Ndl v / AUTOD <br />N <br />N <br />Q070630669 <br />07/06/2018 <br />07/06/2019 <br />...,.. <br />,_..�...,,.�,�,.. <br />BODILY INJURY (Per accident} <br />.. ......... <br />$ <br />HIRED NON -OWNED <br />li vIROPE RTY u1 WAti E <br />AUTOS ONLY AU1-OS ONLY <br />„(6„e,�+r dtr t tTuxO ,„...... .... <br />UMBRELLA LAB OCCUR <br />LAC H 0CCURIIYF:IN E <br />$ <br />EXCESS LIAB CLAIMS -MADE <br />AO0RE-GATL <br />", <br />DID D I4.FIF:N7I10N; $ <br />WORKERS COMPENSATION PER 01 H- <br />ANY CEROPIRIEI-OR/PA TNERE--XECUCIVE YIN X FACHACC F:R F <br />D OFI IC ER"MEMBER F XCI UDrD7 NIA N Q877800181 03/28/2019 03/28/2020 CIULNI. $ 100000 <br />rye4 descry e under L DISEASE u F F�IrF oYIE E $ 100000 <br />( Y' P <br />DESCRIPTION OF OPFRXT IONS below V..._ ... P , N -0 00 <br />any a s in T L uJu o-A. Er.-.IFC11.uQ:Y I_Ii,vuF $ 500000 <br />LIQUOR LIABILITY Each Common Cause 1000000 <br />E N N LL99768 05/19/2019 05/19/2020 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <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 />227 W Jefferson Blvd Suite 1316 <br />AUTHORIZED REPRESENTATIVE <br />South Bend IN 46601 <br />FBX: Email: © 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />