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From: Ellen McDonald Fax: 1574Z347788 To: 5742873677@rcfax.com Fax: (574) 287.3677 Page: 3 of 3 06/0612019 2:26 PM <br />'""'" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br />6/6/2019 <br />THIS CERTIFICATE <br />ICAT IS ISSUED SA MATTER O INFORMATION ONLYAND CONFERS NO RIGHT'S' UPON THE CERTIFICATE' HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY ORNEGATIVELY AMEND EXTEND OR BELOW. THIS ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A REPRESENTATCONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />IVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate tToldrxrt i-s an ADOIT'IONAL INSUREt3, the pollcy(ies) the terms and cmust be endorsed,. If SUBROGATION IS WAW-0 sulaject to <br />certificate holder in lieu of such nemenntt(s}. onditions of the policy, cefl pDilcies may require an endorsement. A statement on this certificate does not confer rights to the <br />edors <br />PRODUCER <br />E57 <br />McDonald <br />Lee Insurance Group 4)234-7788331 S. Eddy Street tszalza3-zszz <br />@leeagency.com <br />P.O. Box 1975INSURER $1 AFFORDING COVERAGE' NAIO# <br />South Bend IN 46617-1975Bend. Mutual. ins. CO. <br />INSURED <br />Hamiltons Towing LLC INSURER B - <br />4707 W Western Ave INSURER C <br />MSURER D <br />South Bend IN 46619 <br />9NSURER F r. <br />COVERAGES CERTIFICATE NUMBER:18/19 <br />INDICATED, NOTWITHSTANDING ANY REQUIREsvr nrewc t 01141U OhLLAVV HAVh BkFN ISSUED TO THE INSUREDNAM <br />ENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUM <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. <br />R <br />'. TYPE OF INSURANCE N POLICY NUMBER POLICY EFF' POLICY EXP <br />MMIDOIYYYY mlwoofYYYY' <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />GEN'L AGGREGATE LIM�IE: <br />POLICY P(A <br />Jf C <br />CA I IHE R <br />AUTOMOBILE LIABILITY <br />A x ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AAUTOS UTTOS <br />OS 2172600 02 9/30/2018 9/30/2019 <br />HIRED AUTOS NON OWNED <br />UMBRELLA LIAR OCCUR <br />E %CESS LIAR CLAIMS -MADE <br />DIED RE:TENIION t <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />AN YPd",AIFTd! r D,IE:SrSE C'1.M"S"'ItP kE; <br />A (MFII"tSA'trMl NN{IEIYEA4CLI,kLIFO't NIA <br />(Mandal0rV In NHI 2172 601 02 <br />P ve a'.lnsrrlh�) iarvrtmr 9/30/2018 9/30/2019 <br />A IGarage Keeper's Legal Liab. ^ R2172600 02 9/30/2018 9/30/2019 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />CERTIFICATE HOLDER <br />CANCELLATION <br />EVISION NUMBER: <br />V AUVVlz FUH ,HIE POLICY PERIOD <br />ENT WITH RESPECT TO WHICH <br />THIS <br />IS SUBJECT TO ALL THE TERMS, <br />LIMITS <br />EACH OCCURRENCE <br />P' a <br />FfiP MI"rT,A� iE`, uctl)tPenr„ <br />$ <br />MED EXP {Any one )01Snin) <br />$ <br />PERSONAL & ADV IN,IUI Y <br />S <br />GENERALAGGRr(,KrL <br />$ <br />11000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per occident) <br />$ <br />Pe'oc"d al A <br />$ <br />Uninsured matorist com6ineo mrit Vo <br />$ <br />11000,000 <br />$ <br />EACH OCCURRENCP <br />AGGREGATE' <br />$ <br />$ <br />PAl UTI' ; 7 <br />t <br />�E�IEACH <br />ACCIDENT <br />$ <br />_ <br />5'00, 000 <br />E.L, DISEASE - LA EMPLOYEE <br />$ <br />50D, 000 <br />E.L. DISC APSE -POLICY LIMIT Is <br />50o,000 <br />aI00,D00omit <br />$1,000 dedn. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />South Bend Code Enforcement Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Petrick Kennedy/EMM <br />01998-2014 ACORO CORPORATION. All rights reseF <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />INS025 (201401) <br />