PSA - Security Services for COVID Isolation Quarantine Center - Mikolajewski & Associates, Inc.

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DATE (MMIDDNYYY) A .AC"R"CERTIFICATE OF LIABILITY INSURANCE 04/15/2020 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 endorsement(s). PRODUCER CONTACT ss Ledgestone Insurance Group PHONE D309 on E266e2507--- jj ,Nra}:(309 26'3-2510 410 N. Main Street WC. NtsxEXII ( ) I ) East Peoria IL 61611 INSURETS) AFFORDING COVERAGE NAIC p A Secura Insurance Companies 22 593 INSURED (DIG) z3u-yoze Mikolajewski & Associates, Inc INSURER6: INSURER C.' 325 S Summit Dr INSURERD: South Bend IN 46619 ,.INSURER ,E: INSURER F : COVERAGES CIFIRTIFICATIF NIIMWIRFR-Cart ID 49RG RFVISIAN NIiMRFR- 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. IN SRR AI}7LNF.... TYPE OF INSURANCE POLICY NUMBER POLICY EF MMIQ Yk YYY.. ........... . .-. F � PC,7LL..Y E14ir. MMIDD 7 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I I DAMAGE 701t6NT0 .- �CLAIMS-MADE ! X,I OCCUR CP003314278 12/01/201912/01/2020 PREMISES.(Eaaccurrggqg) $_ 100,000 F MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY .-, $ 1,000,000 GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000 000 _., .. PRO- , ..... ............._. POLICYJECT �„ �LOC PRODUCTS COMP/OPAGG $ 2,000 000 OTHER: $ AUTOMOBILE LIABILITY COMBI N ED SINGL E LIMIT (Ca„a,cldont), $ 1,000,000 ANY AUTO CP003314278 12/01/201912/01/2020 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS ��,,. _. BODILY INJURY (Per accident) .---___ $ X„ HIRED X NON -OWNED PROPB.RTY�DAMAGE . $ AUTOS ONLY AUTOS ONLY (Farr A idgcrl) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N .--- STATUTE ,' OIL.,..... ANYPROPRI ETOR/PARTNER/EXECUTI VE OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE EA EMPLOYEE $ If yes, describe under _, DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability CP003314278 12/01/2019 12/01/2020 Each "Wrongful Act" $ 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. Department of Community Investment 227 W Jefferson Blvd AUTHORIZED REPRESENTATIVE Suite 1400 S South Bend IN 46601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Paqe 1 of 1