Sidewalk Cafe - 609-613 E. Jefferson Blvd.

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A� DATE'MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/15/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER CONTACT David Giles NA South Bend IN 46617 INSURE F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. bOL INSR ------- P TR TYPE A .... . . OMY NUMBER pOLI.... F POL&CY EXP' E OF INSURANCE 5UB POLICY .... ......... LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 � cm�+tk Aof TON Ntl I .. 300000 „p CLAIMS -MADE OCCUR P�R(rMq,SF�(Esyorr�t.rvrmae�q:a) $ _ ........ ........ ..--------..- ......... ....y MED EXP IAny one person ) $ 10000 A Y N 09013483 10/09/2019 10/09/2020 PERSONAL& ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ 2000000 PRO - X POLICY POLICY JECT PRODUCTS - COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY MBIN_D SINGLE LIMIT I ¢I acz IdacI $ _. ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED .___------- BODILY INJURY (Per accident) _ _ ............ .. ... $ .., AUTOS ONLY AUTOS ...... ..... .,, HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY tralkanl). $ UMBRELLA LIAB OCCUR -- - EACH OCCURRENCE $ �- EXCESS LIAB CLAIMS -MADE , ....,,.. AGGREGATE$ E RETENT L ON $ WORKERS COMPENSATION PER OTH AND EMPLOYERS' LIABILITY Y/N ,5TATIJTF.„ ,,,, , ER....,,. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? �. N/A E..L EACH ACCIDENT --- ................ ...... $ . ..............__..,,.. ........------------- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If Y ....... .... DESCRIPTION OF OPERATIONS balow E.L. DISEASE-POLICY..Y LIMIT $ Each Occurence 1000000 Liquor Liability DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) City of South Bend is additional insured with respect to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 1400 County City Building AUTHORIZED REPRESENTATIVE South Bend IN 46601 `ax: Emil: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD