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ACORO� CERTIFICATE OF LIABILITY INSURANCE
<br />FDATE(MMIDD/YYYY)
<br />`—�
<br />03/11/2021
<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
<br />GUNTNAME: Karen O'Connell
<br />Bonding &Insurance Specialists Agency, Inc.
<br />(A/CC, PHONN Ext), 708-598-5355 FAX No : 708-598-6686
<br />BISA a McNeil Company, McNeil and Company, Inc. in CA
<br />E-MAIL koconnell mcneilandcom an
<br />ADDRESS: p ycom
<br />dba McNeil & Company Insurance Services Lic# OB67313
<br />13841 Southwest Highway, Orland Park IL 60462-1354
<br />INSURERS AFFORDING COVERAGE NAIC/t
<br />INSURERA: ARCH Specialty Insurance Company A+15 21199
<br />INSURED
<br />INSURER B: AXIS Surplus Insurance Company (A+15) 26620
<br />Environmental Assurance Company, Inc.
<br />INSURER C: Westchester Surplus Lines Insurance Co (A++) 10172
<br />440 South Hancock Street
<br />INSURER D: ARCH Insurance Company A+15) 11150
<br />INSURER E:
<br />Indianapolis IN 46222
<br />INSURER F
<br />THIS IS TO CERTIFY 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
<br />LTR
<br />I TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYYI
<br />POLICY EXP
<br />iMMIDDIYYYYI
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />EACHOCCURRENCE $ 1,000,000
<br />CLAIMS -MADE X❑ OCCUR
<br />12 EMP 71633 12
<br />08/18/20
<br />08/18/21
<br />PREMISES eHENa occurrDence $ 100,000
<br />X `Contractors Pollution Liabilit}
<br />Ohio Stop Gap Coverage
<br />MED EXP (Any one person) $ 5,000
<br />X Incl. Asbestos & Lead Ops
<br />PERSONAL& ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER-
<br />GENERAL AGGREGATE $ 2,000,000
<br />POLICY ❑X PRO-
<br />El LOC
<br />JECT
<br />PRODUCTS -COMP/OP AGG $ 2,000,000
<br />"Per Claim $ 1,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $
<br />ANY AUTO
<br />Ea accident
<br />BODILY INJURY (Per person) s
<br />OWNED SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident $
<br />$
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />12EMX0531106-$5MM
<br />08/18/20
<br />08/18/21
<br />EACH OCCURRENCE $ 20,000,000
<br />B
<br />X
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />EBZ640464012020-$10MM
<br />AGGREGATE $ 20,000,000
<br />C
<br />671821791 001 - $5MM
<br />DED RETENTION $
<br />444P' Ammtm PI
<br />$
<br />D
<br />WORKERS COMPENSATIONPl
<br />Y
<br />_
<br />X
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />EBWCC0000412
<br />08/18/20
<br />08/18/21
<br />STATUTE ER
<br />OFFICER/MEMBEREXCLUDED' ❑N
<br />N/A
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />I(Mandatory in NH)
<br />If yes, describe under
<br />E.L- DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />AONTRACTO
<br />MOLD OPS CLAIM MADE FORMRS POLLUTION LIABILITY
<br />Y
<br />Y
<br />12 EMP 71633 12
<br />08/18/2008/18/21
<br />$1,000,000 - OCCU
<br />URRENCE LIMI
<br />PROFESSIONAL LIABILITY - CLAIMS MADE FORM
<br />$1,000,000 - PER CLAIM
<br />$1,000,000 - AGGREGATE
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />ALL PROJECTS DONE DURING THE CAPTIONED POLICY TERM.
<br />rrra.ri r c RUL.ucrc CANCELLATION
<br />City of South Bend
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />227 W Jefferson Blvd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />South Bends, IN 46601 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />kao —A 4Q ,-p_
<br />CA4
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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