License - Renewal for Public Parking Facility - 100 W. Navarre St., 621 Memorial Dr., 707 N. Michigan St.

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�C� 0 DATE (MM/DDIYYYY) `f CERTIFICATE OF LIABILITY INSURANCE 9i30i2022 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 The Horton Group PHONE FAX 10320 Orland Parkway pvc 708-845-3000 JC, No): Orland Park IL 60467 ADDRESS- eertiflcgtesMthehortonaroumoom INSURED BE, Beacon Health System, Inc; Beacon Medical Group Memorial Hospital of South Bend, Inc.; Elkhart General Hospital Community Hospital of Bremen 615 N Michigan Street South Bend IN 46601 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Medical Protective 11843 INSURER B : Selective Insurance ComDanv of America 12572 INSURER F : COVERAGES CERTIFICATE NUMRFR- 147R7RS115 RFVI-RlnN MIIMRFR- 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, INSR E)OLr'iS 1t3R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE@10.,POLICY NUMBER DDfYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR l-- -. � Y Y H002223 10/1/2022 .1MIyI1DD1YYYYl 10/1/2023 EACH OCCURRENCE $ 1 000,000 PPREM SES Ea occurrence $ 100 000 X MED EXP (Any one person) $ 5,000 1,000 _ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3.000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER: ^ POLICY1:1a jECOT E LOC PRODUCTS - COMP/OPAGG $3.000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y S 2547491 8/13/2022 I 8/1312023 COMBINEDSINGLE LIMIT ..{Ea atiC.dent) $ 1,000,000 $ ANY AUTO BODILY INJURY (Per person) OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE P0� a, cldent $ A UMBRELLA LIAB OCCUR HX E002223 10/l/2022 10/1/2023 EACH OCCURRENCE $15,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTIONS9,,nnn S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER EL. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A EL. DISEASE- EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCR.PT10N OF OPERATIONS below EL. DISEASE - POLICY LIMIT I $ A Medical Malpractice Shared Limits H002223 10/1/2022 10/1/2023 Incident 500.000 A Mad Malpractice Separate Limits H002223 10/1/2022 10/1/2023 I n99degate UAggregate 00 15,0,0 0500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Annual Parking Garage License: CMS, Bartlett and Navarre Garages. CERTIFICATE HOLDER CANCELLATION City of South Bend 227 W. Jefferson Blvd. Suite 1400 South South Bend IN 46601 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD