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ACORa CERTIFICATE OF LIABILITY INSURANCE `/ F DAW(MMIDDIYYYY) 1 08/24/2021 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 Church Mutual Insurance Company, S.I. Schuster Lane P.O. Box 357 Merrill WI 54452 CONTACT NAME: Church Mutual Insurance Company, S.I. PWHOKES. EILL 1-800-554-2642 Option 1Fac 855-2642329 IAX3000 ADDRESS: customerservice@churchmutual.com INSURER(S) AFFORDING COVERAGE NAILS INSURERA: Church Mutual Insurance Company, S.I. 18767 INSURED INSURER B SOUTH BEND PENTECOSTAL CHURCH OF GOD IN CHRIST INSURERC: 1025 W WESTERN AVE INSURER D: NSURER E: SOUTH BEND IN 46601-2751 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. ILTR TYPE OF INSURANCE AWL SUB POLICY EFF POLICY EXP POLICY NUMBER MMNCIYYYY MMIDDI UNRS X COMMERCIAL GENERAL LIABILRY EACH OCCURRENCE 1,000,000 CLAIM$ � E -MADE OCCUR PREMISES Ea occurrence $ 100.000 MED EXP (My one person) E 10,000 A _1 Y 031398025-196936 03/16/2021 03/16/2022 PERSONA.&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPjPLIE�S PER: GENERALAGGREGATE $ 3,000,000 X POLICY ❑ JECT LOC I_J PRODUCT$-COMP/OP AGG E 1,000,000 OTHER: E AUTOMOBILE LUBILRY SINGLE LIMIT ANY AUTO ICE BODILY INJURYIPa/person) $ OWNED SCHEDULED BODILY INJURY (Per acdtlenQ E AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per ao:kknt UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LLA. LAIMB-CMADE AGGREGATE E DED RETENTIONS $ WORKERS COMPENSATION PER ANDEMPLOYERS'L.1MM.RV YIN STA T ER E.L. EACH ACCIDENT E ANYPROPRIEfOWPART,IEPoEXECUTIVE OFFICE R,MEMBEREXCLUOED> ❑ NIA (Mand=in NH) de nbe unser E.L. DISEASE - EAEMPLOYEE $ E.L. DISEASE-POLICYUMR $ ,Yes DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AOdiUonal Remarks SchWule, may M anachee If man apace ie requinxu Certificate Holder is an additional insured as required by written contract or agreement per the General Liability Enhancement endorsement attached to the policy. City of South Bend Board of Public Works 227 West Jefferson South Bend SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE IN 46601-1830 5ACORD I he AOURD name and logo are registered marks of ACORD reserved.