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<br />CERTIFICATE OF LIABILITY INSURANCE Fa r�r ^ 1DDIYYYY)
<br />DATE (MM
<br />r'a..
<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 6,01s to the certificate holder in lieu of such endorsementts).
<br />PRODUCER
<br />The Church Insurance Agency Corp
<br />210 South St, Ste 2
<br />Bennington, VT 05201-2894
<br />Church Ins Co of Vermont
<br />INSURED Cathedral of St James
<br />117 N Lafayette Blvd
<br />South Bend, IN 46601-1507
<br />10669V
<br />COVERAGES CERTIFICATE NUMBER:
<br />E SION NUMBI�R:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
<br />NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
<br />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 />IN3R TYPE OF INSURANCE ADD L SUER POLICY NUMBER POLICY EFF POLICY EXP
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH 1
<br />�
<br />CLAiMS,MADE ^ 7 OCCUR N N VPP0006095 5/112019 5/1/2020
<br />� 1'000,000
<br />.. DAMAGEr 4r oa 000,000
<br />E,X,P, fAnv,,,one erson g 30,000
<br />PERySQNAt mAbDV INJURY 1,000,000
<br />Gk,NPO -jo APPLIESLOC
<br />GENERAL s 000,000
<br />dOvl
<br />PRo„AGGREGATE„
<br />1,000,000
<br />DIaCTS • cOMPrOP acG s 1,
<br />OTHFf
<br />s
<br />AUTOMOBILE LIABILITY
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<br />_C�'h+{E�O�NFD.�VPkG1117w9fT..
<br />ANY AUTO
<br />DILY TL URY F r pecsnn)w.
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
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<br />Y Psr accident 5
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<br />I er auci dnl mm 5
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<br />S
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE $
<br />EXCESS LIAB CLAIMS -MADE
<br />u..
<br />AGGREGATE_ ,, ........... ... .. __- .a
<br />DED RETENTION $
<br />S
<br />WORKERS COMPENSATION
<br />EMLOYIA
<br />ATH
<br />4aTTIE..
<br />YIN
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<br />ANY PROPRIEfgORIPARTNERIESCECUTIVE
<br />E 1. FACH 4GClDENT
<br />ericCl Cf1 IUFHRI EXCLUDED? NIA
<br />. .- ...
<br />F.L.. DISEASE EA EI1 PLOYFE S
<br />_
<br />If yes, describe under
<br />....' ................."".. ".
<br />ESCRIPTION OF OPERATIONS Wow I
<br />li' E,L, DISEASE # POLICY LIMIT S
<br />A Umbrella N N PP0006095 511/2016 5/1/2017
<br />Excess Liability 4,000,000`
<br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES be attached if more space is required)
<br />VEHICLESACORD 101, Addkf anal Remarks Scheduler, n'k
<br />Church parking, lot used as public facility, city named as an .additional insureda�
<br />CANCELLATION: THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR
<br />EACH POLICY PERIOD. SHOULD THE
<br />POLICY BE TERMINATED, THE COMPANY WILL ENDEAVOR TO GIVE THE ADDITIONAL INTEREST IDENTIFIED 30 DAYS WRITTEN NOTICE, AND
<br />WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD EFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY
<br />'PROVISIONS OR REQUIRED BY LAW.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W Jefferson Blvd., Ste 1400 South
<br />South Bend, IN 46601-
<br />AUTHORIZED REPRESENTATIVE
<br />10
<br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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