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

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AcnRna, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) �%� 1 9/30/2022 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 The Horton Group 10320 Orland Parkway Orland Park IL 60467 INSURED t31u 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 COVERAGES CERTIFICATE NUMBER: 1476296115 NAME: 708-845-3000 INSURERA: Medical Protective INSURER B : Selective Insurance INSURER C : INSURER F,. FAX IA/D. No) M19-up.cDm tDING COVERAGE :ompany of America REVISION NUMBER: NAIC # I 12572 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, INS SUB,TYPE OF INSURANCE 06L POLICY NUMBER POLICY EFF MM/DDIYPOLICY YY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y H002223 10/1/2022 10/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE t - - t OCCUR l0f'A'E� IETI7ED PREMISES7Ea occurrence)$ 100,000 MED EXP (Apy. one person) $ 5,000 X 1,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY El I Ll LOC PRODUCTS - COMP/OP AGG $ 3 000 000 $ OTHER: B AUTOMOBILE LIABILITY Y Y S 2547491 8/13/2022 8/13/2023 00MBINED LIMIT accidrm!) $ 1,000,000 $ ANY AUTO BODILY INJURY (Per person) OWNED SCHEDULE AUTOS ONLY AUTOSBODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY rX PRpPRT%DAMAGE ft accident $ A UMBRELLA LIAR OCCUR E002223 10/1/2022 10/1/2023 EACH OCCURRENCE $15,000,000 X EXCESS LIAB X CLAIMS -MADE AGGREGATE $ 15,000,000 DED X RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN TATUTE ER E,L EACH ACCIDENT $ ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ N/A E,L. DISEASE - EA EMPLOYEE $ (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Medical Malpractice Shared Limits A Med Malpractice Separate Limits H002223 10/1/2022 H002223 10/1/2022 10/1/2023 10/1/2023 Incident Aggregate Incident/Aggregate 500,000 15,000,000 500,000/ 1,500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Annual Parking Garage License: CMS, Bartlett and Navarre Garages. VCRI Iri%,mia n%JLUCK 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 _:i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD