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CERTIFICATE OF LIABILITY INSURANCE ! DATE(MMIDD/YYYY)
<br />11 /21 /2019
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO CERTIF
<br />BELOW. THIATES CERTIFICATE N LATE IR INSURANCE DOES NOT YAMEND,CONSTITUTE A CONTRACT BETWEEN THE ISSUING
<br />_ .... ,.,_ P IES
<br />UPONTHE CERTIFICATE HOLDER. THIS
<br />DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />..� . �w. _FerP ._.y�'.._..)...... m_.... IT..
<br />If IMPORTANT
<br />t1ii WAIVED, subjects an AODIi _ '
<br />to the terms and conditions ofthepolicy, certain policiesmayrequire San a endorsement. nt. A statement
<br />endorsed.
<br />IONAL INSURFO tla ollc es must have ADDITIONALyant. A„statement on
<br />vROD!ucI Rrtificate dogs
<br />such endorsement s
<br />_ not confer rlwgtat to the certificate holder in lieu of d5k�
<br />The Horton Group NAME°
<br />340 Columbia Place WC,N,a.Exl1 708-845-3917 NE FAX
<br />Nw4 866-202 5917
<br />South Bend IN 46601 E-MAIL
<br />ADDRESS. cellificates(f thehortongroup.com
<br />INSURER(S)AFFORDING COVERAGE NAIC0
<br />INSIIUREIIII A,: 117rwa".W cM FlimRti; ctive 11843
<br />INSURED BEAOHEA-03 INSURERS: Amerisure Mutual Insurance Co. 23396
<br />Beacon Health Systr�nl lac,; Beacon Medical Group; Memorial
<br />Hospital of South Bend, Inc.; Elkhart INSURER C
<br />General Hospital Community Hospital of Bremen INSURER D p
<br />615 fit M'ichi an Street IN$UREGNE:
<br />South Be'ndN 46601
<br />ES CERTIFICATE NUMBER 1732807401 REVISION NUMBER
<br />THIS IS rl1 C.LRTIt'Y THAT THE POLICICS OF INSURANCE LISTED BI,tOW' HAVE BEEN G'"tlED 7O THE INSURED NAMED AE30VE FDft THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER 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 />1GN,' ^ P' lP H002223�.,.. �- .i.., - t ..0 FACHOCCCII�CCNCE IMITS
<br />OF .., ... ,...., _ P0480w 12/1I�20 9 _ 1211l2020� ,... ...............�•��..
<br />SR ADOL. S'URR` " O'AMdWGE T4J RCN"q 4:C5
<br />......... NUMBEtt _
<br />t
<br />._......,-.............. _ ...:.. d4tlM YYYY MRDDJVYY L..._
<br />A X COMMERCIAL GENERAL LIABILITY $1,000,000
<br />CLAIMS -MADE % ......� OCCUR PREMISES, Ea rt:r„uwrenao'. $100,000
<br />MEO EXP (Any one person) $ 5,000
<br />PERSONAL& ADV INJURY $1.000.000
<br />GEN'L AGGREGATE LIMIT APPLIES PER: P,D'NFR,ALA'GGREGATE 53,000,000
<br />JET LOC
<br />PRODUCTS -COMP/OP AGG $3,e00„000
<br />POLICY El
<br />. ... - OTHER
<br />.. ..Aµ .�..... _.,.,....,...... ....... __...
<br />B AUTOMOBILE LIABILITY -�---CA13212592802 0/13/2019- a113/2020..dIl`8t�.iLINY6 - $1,000,000
<br />ANY AUTO BODILY INJURY (Per person) $
<br />x OWNED SCHEDULED
<br />AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
<br />x,, HIRED X NON -OWNED TY9:fdtitdtAGE
<br />AUTOS ONLY PROPERTY , AUTOS ONLY PE daru9j $
<br />.Ax UM.., .,..�,... ,..,..4-e..e.. $
<br />BRELLALIAR - .........m...,.., ,.-...........,, .....,.... .........
<br />OCCUR E002223 12/l/2019 12/112� F _.. URR� � 020 P.,r4CHOCCURRENCE $25,OOD,000
<br />EXCESS LIAR X CLAIMS -MADE AIJGRCr;ATE. $ 25,000,000
<br />AND EMPLOYERS' L ABILIITY ---
<br />h7EU RE"rENrkON
<br />WORKERS.. ,.._ Y�� ..... ,,,,. .n......., ,�.....,._.......... ... �....�.....-„-.. ... , �,._, ....,,,,.n., .....w STATUTE..... . .1f... ......,-,.._
<br />dNYPROPRIE"C0RiPAR'1NFwFxIW`CU1nVE N
<br />OFrICCRWEMBEAEXCLUDED"P NNA , E.L. EACH ACCIDENT $
<br />(Mondatoly In NI�4) E.L. DISEASE - EA Er,RKOYEI:. $
<br />A Ifs vk,scr9tae under
<br />RMedical Malpractice Shared Limits H002223
<br />Of OP OLSORIPB'Nr,?N OPERATIONS &aa@rxrr _ E L DISEASE P`FJI f Y 9 AMn
<br />.a.�.,_.. ...�,,., � -..�.. ,.,.... � .-....-,- ....�_.� ....... . �.,.....- ....awrr1211/2019 1211/2.,. ...... -.-. w..
<br />020 Incident
<br />Mad Malpractice Separate Limits =ate UAggragate 15,000,000
<br />500, 000/1, 500, 000
<br />DESCRIPTION OF OPERATIONS I LCh�C:A'tioNS J VEti. CLES(ACORD $01, Ad .,. m... a Schedule,
<br />.,.....,...,�. d If rna _m......... is r .............._... ...,,....... .,..wMrv.._...._. w,,,,,..�,�,....
<br />.. dVtaxara�l Rarraarks SoYned�rte array Ire'aNadctuad WN rngre Apace 9s reparured)
<br />Additional Named Insureds. Beacon Spedally Surgery Center, L LC; Beacon Health, LLC, Beacon Health Ventures, Inc.: Beacon Occupational Health, LLC.
<br />Qualified under the Indiana Patient Compensation Fund.
<br />Annual Parking Garage License: Centennial, Bartlett and Navarre Garages
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of South Bend ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W. Jefferson Blvd. Suite 1400 South AUTH_D'_ORI2EREPRESENT ATIVE
<br />South Bend IN 46601
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<br />�RP reserved.
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