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NIEZPLU-01 <br />40�CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br />6/412019 <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: ff 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 riohts to the certificate holder in lieu of such endomement(s). <br />PRODUCER <br />Daft Beny Insurance Agency Inc. PRONE <br />64101 Ironwood Road 18& Nay Ertl: (574) 255-6222 <br />South Bend, IN 46637 Jokss, busines cibirm <br />INSURED <br />Nlezgodski Plumbing, Inc. <br />PO Box 3096 <br />South Bend, IN 40619 <br />F: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHEI <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIE <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />R TYPE OF INSURANCE JA <br />, 5 . POLICY NUMBER raPi wLIaw YsvEvPrFvz 1. trinnnwr <br />I_1 <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CUMMS-MADE [�] OCCUR <br />L AOORE TE LIMIT APPL S PER: <br />POLICY j&OT- LOC <br />8/21/2018 1 8/21/2019 <br />AUTOMOBILE LIABILITY 'I <br />X ANYAUTO 495062 8/21/2018 8/21/2019 <br />OWNED SCHEDULED <br />AURRTEEO��S ONLY AUTOSy <br />A�TOS ONLY At9i0 Q <br />A UMBRELLA LIAB AI OCCUR <br />EXCESS LIAR CLAIMS -MADE �A4950632 8/21/2018 6/21/2019 <br />DED I I RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNERIEXECUTIVE YIN C0190699-01 8121I2018 812112019 <br />9-1il.- al�in RIM EXCLUDED? N ! A '. <br />If vee, dfireeasvibe 1uuFnid)er <br />254-2630 <br />IED NAMED ABOVE FOR THE POLICY PERIOD <br />t DOCUMENT WITH RESPECT TO WHICH THIS <br />ED HEREIN IS SUBJECT TO ALL THE TERMS, <br />LIMITS <br />_..� CUEN 15000,000 <br />AG� T <br />O RENTED 9$ 300,000 <br />MED EXP 5,000 <br />PERSONAL 8 ADV INJ RY 1,000,000 <br />OENERALAGGREGATE <br />2,000,000 <br />PRODUCTS - COMP/OP AGG <br />2,000,000 <br />COMSINED SINGLE �.WfT <br />1,000,000 <br />BODILY INJURY (PE@ oeusnn) <br />BODILY INJURY (Per accidBnt <br />r %tOPentEft Y AI IAGE <br />2,000,000 <br />EACH OCCURRENCE <br />AGGREGATE <br />s 2,000,000 <br />X PER 0 <br />E�,m,mm-EAGHAC I ENT <br />500,000 <br />EL. DISEASE -EA EMPLOYEE <br />S 600,000 <br />500,000 <br />OI E E -POLICY IICCY LIM <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 />City of South Bend Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ty ACCORDANCE WITH THE POLICY PROVISIONS. <br />227 W. Jefferson Blvd. <br />South Bend, IN 46601 .. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 2512016103) 01988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />