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CERTIFICATE OF LIABILITY INSURANCE °"'E`""'°°"'""' 04/07/2021 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 polity(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 certificata does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Pamela Clark NAME: WalkerHughes Insurance 918 Fry Road, Ste E PHONEFt,(317J 786-9236 PAXAX Rp: (317)788-4896 L ADDRESS: p.dark®walkerhughes,oDm INSURER(S) AFFORDING COVERAGE NAIC S Greenwood IN 46142 INSURER A: Star Insurance 18023 iNSURED INSURERS: American Interstate Insurance Company 031895 Water Solutions Unlimited Inc. INSURER C : 8824 Union Mills Dr INSURERD: PO Box 157 INSURER E : Camby IN 46113 INSURER F: COVERAGES CERTIFICATE NUMBER: 20-21 REV#2 RFV1SU11 J W"IMIRRR• THIS IS TO CERTIFYTHAT 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ING TYPE OF INSURANCE O WVD POLICYNUMBER POLICY EFF DI POLICYEXP NM/DA LWRs COMMERCIAL GENERALLWa1UTY CLAIMS -MADE © OCCUR EACH OCCURRENCE S 1,000,000 PREMISES Eevcwrronce S 300,000 MEP ExP (Any one maw) S 10,000 PERSONAL & ADV INJURY S 1,000,000 A GLOS92692 06/012020 06/01/2021 GEN'LAGGREGATE LIMITAPPLIES PER- ]C POLICY jECT Lac GENERALAGGREGATE S 2,000.000 PRODUCTS -COMPIOPAGG S 2,000,000 $ OTHER AUTOYOBILELIMLrY COMal4E0 SINGLE LIMIT Ea erridan! S 1,01A000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS CA0692692 06/012020 06/012021 BODILY INJURY (Per acdderd) S HIRED NON -OWNED ALTOS ONLY AUTOS ONLY PROPERTY DAMAGE per an! S s UMBRELLA UAB OCCUR EACHOCCURRENCE S 5,000,000 A EXCESSLIAB rL AIU� uADE UM0692692 06/012020 06/012021 AGGREGATE= 5,000,000 ❑EO I X RETENT[ON $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORMARTNERIEXECUTIVE � OFFICERIMEMBER EXCLUDED? {Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below MIA AVWCIN2901432020 06/012020 06/012021 PER OTT+ ATIJTP ER El_ EACH ACCIDENT S 500.000 E.L. DISEASE - EA EMPLOYEE S 500,0()0 E.L. DISEASE- POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remerb Schedule, may be attached If more space Is required) General Liability, Automobile Liability and Excess Liability provides for additional insured when agreed by written contract or agreement General Liability and Automobile Liability Is provided on a primary, non-contributory basis when agreed by written contract or agreement General Liability and Automobile Liability include a waiver of subrogation when agreed by contract or agreement. Excess Is follow form per the terms of the policy. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson Blvd AUTHORIZED REPRESENTATIVE South Bend IN 46601 e-e� f ' CoC e, 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD