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ACORLC1 <br />'4lkse O CERTIFICATE OF LIABILITY INSURANCE <br />°10125/2021AM Y <br />1or2srzozl <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(les) 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 847-303-6800 <br />Dohn & Maher Associates <br />4811 Emerson Avenue, Suite 102 <br />Palatine, IL60067-7416 <br />CONTACT <br />PHONE 647-303-6800 FAX 847-303-6963 <br />INC. No, Ed): A/c, Na): <br />E-MAIL . certificatesgoohn.com <br />William P. Maher <br />INSUREFUSI APFORDWG COVERAGE NAIC 0 <br />INSURER A: Westfield Insurance 24112 <br />EACH OCCURRENCE S 1,000,000 <br />INSURED Acorn Landscaping, LLC <br />3680 W Sample St <br />South Bend, IN 46619 <br />INSURER B: <br />INSURER C : <br />INSURER 0: <br />. INSURER E: <br />04/0112022 <br />INSURER F: <br />r•nveo An_ce CCGTICICATF NIIMRFR• RFVIRI()N NI IMRFR- <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 />INSRI TYPEOFINSURANCE JAWL <br />SUB <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X COMMERCNALGENERALLIASILITY <br />EACH OCCURRENCE S 1,000,000 <br />DAMAGE TO RENTED SIFa �nG $ 500,000 <br />CLAIMS -MADE EKOCCUR <br />CWP015513X <br />0410112021 <br />04/0112022 <br />ME EXP Any one arson S 5'000 <br />PERSONAL a ADV INJURY S 1'000'000 <br />L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑X jE LOC <br />7THER: <br />GENERAL AGGREGATE S 2,000,000 <br />PRODUCTS - COMPIOP AGG 5 2,000,00 0 <br />A <br />AUTOMOBILELIASIUTY <br />COMBINED SINGLE LIMB E 1,000,000 <br />WI <br />X <br />X <br />ANY AUTO <br />AUTEOE��S ONLY AUTOSSUWLEEp❑ <br />Z'Rs ONLY X ATOS ONLY <br />CWPOISS13X <br />04/0112021 <br />04101120221 <br />BODILY INJURY Per arson <br />BODILY INJURY Perieccidenl S <br />PRLOPERQ 1 AMAGE S. <br />A <br />X <br />UMBRELLA UAB <br />EXCESS LIAS <br />X <br />OCCUR <br />CLAIMS44ADE <br />CWP015513X <br />04101/2021 <br />0410112022 <br />EACH OCCURRENCIE s 5'000'000 <br />AGGREGATE 5'000'000 <br />DED X RETENTIONS O <br />A <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' UASILRY y/ <br />OFFICERME,MBOER EXRCwOE�, ECUTIVE M <br />(Mandkdmy MNH) <br />If jes. desvibe under <br />p CRI TI N OF OPERATIONS b I <br />Installation FIDECWP015513X <br />NIA <br />WCP015556V <br />04/01!2021 <br />04/0112021 <br />04/01/2022 <br />04/01/2022 <br />X I PER OTH <br />1,000,000 <br />EL EACH ACCIDENT S <br />E DISEASE - EA EMPLQYEEI S 1,000,000 <br />- POL Y IMn 1,000,o00 <br />Limit 10,000 <br />A <br />Leased/Rented Eq <br />CWP016613X <br />04/0112021 <br />04/01/2022 <br />Limit 150,000 <br />DESCRIPTION OF OPENATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If mors space is required) <br />The following are included as Additional Insured to General Liability <br />(coverage form attached as required by written contract with respects to <br />work performed by the Named Insured: City of South Bend. <br />CTYSOBE <br />City of South Bend <br />227 W. Jefferson Blvd. <br />South Bend, IN 46601 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />ACORD 25 (2016103) v TBaa-tuTo (A1.ufcu a.vrcrvrwl Ivn. .,II ,.yl. o ,e��, <br />The ACORD name and logo are registered marks of ACORD <br />