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CERTIFICATE OF LIABILITY INSURANCE J DATE(MMIDD/YYYY) 7/29/2022 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[sl. PRODUCER Gibson Insurance Agency Inc 202 South Michigan St., Suite 1400 South Bend IN 46601 INSURED Navarre Hospitality Group, LLC 105 W Colfax Ave South Bend IN 46601 NAME:PHO_ FAX WE No. €xt); 574-245-3500 _ I (A)C INSURERS AFFORDING COVERAGE NAIC X A: Cincinnati Insurance Co. 10677 B: Accident Fund National Insurance CompanyCoMpany 12305 c: Accident Fund Insurance Company of America 10166 E: COVERAGES CERTIFICATE NUMBER: 1144034143 REVICI0N NIIMRER• 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 TYPE OF INSURANCE INSD SUER' EFF POLICY EkP LTR POLICY NUMBER NYM IMAND01YYM LIMITS A X COMMERCIAL GENERAL LIABILITY EPP0450028 8/1/2022 8/1/2023 EACH OCCURRENCE $1,000.000 TO REN!TED S FEB pccunre $ 500.000 CLAIMS -MADE FTIOCCUR MED EXP one per59nj $ 2,0M PERSONAL 8 ADV INJURY $ 1,0W.000 • GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JERC LOC GENERAL AGGREGATE $ 2,OOD,000 PRODUCTS -COMP/OP AGG $ 2,0DD,000 $ OTHER: A AUTOMOBILELIABILITY X ANY AUTO EPP0450028 8/1/2022 8/1/2023 OOM81NE SINGLE LW Eaacddfl l,____ BODILY INJURY (Per person) $1,000,000 $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY AAiWGE P", PERT*WdS $ A X UMBRELLA LIAB X OCCUR EPP0450028 8/1/2022 8/1/2023 EACH OCCURRENCE $5,ODD,000 AGGREGATE $5,Dp0,000 EXCESS LIAB CLAIMS -MADE $ DED RETENTIONS B B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICEtrMEMBER EXCLUE NIA WCV6148032 WCV6148102 WCV6151513 8/l/2022 8/1I2022 8/1/2022 8/1/2023 8l1/2023 8/1/2023 X y� OTH- IATUT E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE _ $ 500,000 (Msndal" in NH) 1I yyes, describe under DESCRIPTION OF OPERATIONS below 7 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addiitonal Remarks Schedule, may he attached if more space is ragWivd) City of South Bend is additional insured with respect to general liability coverages as required by written contract.; CERTIFICATE HOLDER CANCELLATION 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 South Bend IN 46601 AUTHORIZED REPRESENTATIVE USA © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD