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AC NIEZPLU-01 ANI <br />�..- CERTIFICATE OF LIABILITY INSURANCE DATE4 /20lYYYY)20 <br />8/12/20 <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 rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER CAN ACT <br />Dan Berry Insurance Agency Inc. PHONE <br />54101 Ironwood Road (AIC, No, Ext): (574) 255-6222 (Alc, No):(574) 254-2630 <br />South Bend, IN 46637 E-MAIL w.._:�—- .. <br />INSURED <br />Niezgodski Plumbing, Inc. <br />PO Box 3096 <br />South Bend, IN 46619 <br />F: <br />I;I <br />- RGV WIVIY IVUMt3tK: <br />THIS IS TOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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 />INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP <br />AIND POLICY NUMBER <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE a OCCUR A495062 8/21/2020 1 8/21/2021 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />X POLICY ❑ JECT 1-1 LOC <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />X <br />ANY AUTO <br />OWNED SCHEDULED <br />A495062 <br />8/21/2020 <br />8/21/2021 <br />AUTOS ONLY AUTOS <br />yyN <br />HIRED ONLY AUOT16S ONLY <br />UMBRELLA LIAB I X I OCCUR <br />EXCESS LIAB CLAIMS -MADE I A495062 6/21/2020 8/21/2021 <br />DED RETENTION $ <br />ANY PROPRIETOR/ EXCLUDED? <br />Y� I I �0190699 -02 18/21/2020 18/21/2021 <br />(Mandatory <br />in ER EXCLUDED? N!A <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />LIMITS <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of South Bend Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />227 W. Jefferson Blvd. ACCORDANCE WITH THE POLICY PROVISIONS. <br />South Bend, IN 46601 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) 10 1 988-201 5 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />