Special Event - March to Memorial - September 11

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ACOR6r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) illl,� 1 02/21/2021 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 NAME: Will Maddux East Main Street Insurance Services, Inc. PHONE (530) 477-6521 �, Will Maddux t df: Ng?]: _ E-MAILDSS: Wotheeventhelper.com PO BOX 1298 INSURER S AFFPRbING COVERAGE NAIG9 Grass Valley CA 95945 INSURER A: Evanston Insurance Company 35378 INSURED INSURER B March to the Memorial INSURER C Bob Lyons INSURER D; 52160 Woodsedge Dr INSURER E: Granger IN 46530 INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION Nt1MRFR- 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, )LSA XP rH TYPE OF INSURANCE Amsn DD 5 A ^ POLICY NUMBER PM/DD/YYYY MOCY EFF I ONYYY I LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCURAGETOV EACH OCCURRENCE S 1,000,000 E i PREMISES Ioccurreritley S 100,000 Host Liquor Liability MED EXP (Any one arson) S 5,000 A Retail Liquor Liability Y 3DS5472-M2957824 09/11/2021 09/12/2021 PERSONAL BADV INJURY 5 1,000,000 AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY C PECOT- I LOC 12:01 AM 12:01 AMS PRODUCTS - COMP/OP AGG S 1,000,000 Deductible S 1,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLELI MIT S as "et BODILY INJURY (Per person) 5 ANY AUTO OWNED SCHEDULED AUTOS ONLY II AUTOS BODILY INJURY(Per accident) 5 HIRED NON -OWNED AUTOS ONLY _ AUTOS ONLY PROPERTY DAMAGE pef �Idant S M IS UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE S EXCESS LIAR AGGREGATE 5 DED I : RETENTION S $ WORKERS COMPENSATIONI PER OTH- ANDEMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEj OFFICER/MEMBEREXCLUDED? ❑ N/A STATU j ER EL- EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE S (Mandatoryin NH) If yes, describe under E.L DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder listed below is named as additional insured per attached MEGL 2217 01 19. Attendance: 40, Event Type: Walking Event. t.r-n I Irn,4m I I= nvt_ucn CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of South Bend, IN Special Events Committee AUTHORIZED REPRESENTATIVE 227 West Jefferson Blvd, South Bend IN 46601 U 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD