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MIKO&AS-01 KS 'RUEBI <br />ACORO DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 4/15/2020 <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 />.. ._ —�._... �w <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 />1 n riderck& Sri der Agency, Inc. PO EcT Kim Sirtat3 wng F L <br />PRODUCER <br />y — __..� � AIc N 09 664- <br />1 91Ickngtd Drive W p, Ex9_ (09 664 1800.. <br />Bloomington, IL 61701 E�wAl rt <br />INSURED <br />Mikolajewski & Associates Inc <br />325 S Summit Dr <br />South Bend, IN 46619-2336 <br />COVERAGES <br />..... CERTIFICATE <br />NUII R: <br />R 'V/ISION NUMBER <br />THIS <br />IS TO CERTIFY THAT THE POLICIES OF INSURANCE <br />LISTED BELOW HAVE BEEN <br />_ _p _m <br />ISSUED TO THE INSURED NAMED ABOVE <br />INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, <br />TERM OR CONDITION OF <br />FOR THE POLICY PERIOD <br />ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY <br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />.. EXCLUSIONS, <br />CONDITIONS OF SUCH P <br />_,... <br />MAY HAVE <br />REDUCED BY PAID CLAIMS <br />INSR <br />- <br />TYPE OF INSURANCE DLICIES-.,LIMITS„SHOWN <br />AODL SIyBRA <br />... ...M. <br />.COMMERCIAL <br />-._.A _..... <br />...' <br />POLICY NUMBER <br />.... <br />." "` .."""""" �.....,....-..•— -.- .-. <br />POLNCY EFF POLICY E3fP LIMITS <br />IPcI <br />GENERAL LIABILITY <br />CLAIMS -MADE p OCCUR <br />At Fi CICCRFiC NCE <br />AMAGE'rORINI`ED <br />Y <br />MFMl,' FO. J! FRS r �FK C 9 _ ...._ <br />AOV IN J �._. <br />CENL Cf'REGA�F <br />A R- LIMIT APPLIES PER. <br />POLICY Y E <br />PLY LOC <br />G�MTUFtY.. <br />E _.. <br />A , ECT <br />PROOUCT'S_ OONVF�dCd' <br />OTHER, <br />.... _. ...�.: <br />.....W®.... _.._ <br />... """'".. _ <br />AUTOMOBILE LIABILITY <br />INED INCLELI MIT <br />...i„�k..a '�Dl- $ <br />ANYAUTO <br />OWNED SCHEDULED <br />OD%LY %IIJNJRY % or eryuar <br />�' �, � �. <br />AUTOS ONLY a AUTOS <br />HIR D NL'N-(') N�IJ.P'OPERTYSAMACE,.� <br />AU OS <br />__ <br />aOYRLW %aB l "F,�PeCrrridesal, .."," _ .... .—.....,. <br />ONLY _ A TOa YhJLY <br />Iera cld nI _ <br />UMBRELLA LIAB OCCUR <br />T <br />EXCESS LIAB CLAIMS -MADE <br />EAgFt LYCCLBdiRENCE . <br />—... _........._.. <br />RETENTION $ <br />KERSCOMPENSATL�--PERONYIiFEDED <br />EMPLOYERS LIABILITY <br />X �€iWl <br />ANY PRO'PRiETORrFAraTNERIE7tECLR'ItVE <br />PRCE FM <br />53000022 8191 <br />511/2019 511/2020 500,000 <br />@,hB�qR� E,XCi.UDEE7�'Y N / A <br />Mandatory n gI <br />cm CRI NT _,.._ _ e. .......,..._. _ _ ,.. <br />If es, de r bo under <br />t1 <br />L % rr l4S EA F MPI OYR E Sl flrtll7l% <br />._..... wl....._ ._, ..-...__. _,,... �_ <br />...._. <br />SDI... TION,OE OPEIt6TIONS t gt.Lr _ <br />E t„ D%SE'ASE —POLICY Y L%MI% %MI8"' - 500,0'00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required <br />. .�.�.� a ..�-.._._ _ <br />CERTIFICATE HOLDER �...�-.. „ . _._.. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of South Bend Indiana THE EXPIRATION DATE THEREOF„ NOTICE WILL BE DELIVERED IN <br />Department of Community Investment ACCORDANCE WITH THE POLICY PROVISIONS. <br />227 W. Jefferson Boulevard, Su'tte 1400, S. <br />South Bend, IN 46601 AUTHORIZED REPRESENTATIVE <br />f <br />.......�—._... _... "'.Fa.. .. <br />_..RD 25 ..... ....... —. _.... ........._ . �.M. ........ <br />ACO(2016I03) The ACORD name and logo are registe <br />..... ©1988-2015 ACORD CORPORATION. All rights reserved. <br />red marks of ACORD <br />