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CERTIFICATE OF LIABILITY INSURANCE <br />DATE IMMIDDIYYYY) <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 pollcy(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 endorsements . <br />PRODUCER CANTACT David Giles <br />The Leadership Insurance Agency, Inc. HONE . 574-277-1611 574 273-4557 <br />52303 Emmons Road L • david@leadershipins.com <br />Suite 31 INS R S AFFORDING COYERAOE NAIC6 <br />South Bend IN 46637 1 INEMBE-RA: AUTO -OWNERS INS CO 18988 <br />INSURED INSURER R, <br />The General Deli LLC <br />609 E Jefferson Blvd <br />E: <br />South Bend IN 46617 <br />rn►oeo nr_r=c reaYIeu�ATF &111MC 97- Rl`►l1AfAN NI IMRCR <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. N07WITHSTANDING 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 />1H R <br />TYPE OF INSURANCE <br />AD <br />91100 <br />POLICY NUM ER <br />>° UCYEFF <br />POU F_X <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE ® OCCUR <br />Y <br />N <br />09013483 <br />10/09/2022 <br />10/09/2023 <br />EACH OCCURRENCE <br />S 1000000 <br />s 300000 <br />MED EV LAM am pamm <br />S 10000 <br />PERSONAL SAOVINJURY <br />S 1000000 <br />GEN'L AGGREGATE LIMRAPPLIES PER: <br />POLICY©J T LOC <br />OTHER: <br />GENERAL AGGREGATE <br />S 2000000 <br />S 200D000 <br />PRODUCTS-COMP/OPAGG <br />S <br />AUTOMOBILeuAvt IiY <br />ANY AUTO <br />OWNED I SCHEDULED <br />AUTOS ONLY _ AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />COMSIN@DSINGIJ:LOrSiI <br />S <br />BODILY INJURY (Per person) <br />S <br />BODILY INJURY (Per accident) <br />S <br />kpYER7Y➢ANWGE <br />S <br />S <br />UMBRELLA LIAB <br />EXCESS UAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />S <br />RETENTION <br />S <br />WORKERS COMPENSATION <br />AND EMPLOYEJW LIABILITY Y I N <br />.ANY PROPRIEfORIPARTNERIEXECUnVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />lr em desabs undor <br />F OPERATIONS below <br />NIA <br />E.L.EACH ACCIDENT <br />S <br />E.L. DISEASE -EA EMPLOYEE <br />S <br />EL DISEASE -POLICY LIMIT <br />S <br />A <br />Liquor Liability <br />N <br />N <br />09013483 <br />10/0912022 <br />10/09/2023 <br />Each Occurencs <br />1000000 <br />DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (ACORD 101, Addlttonal Remarks Schedule, may be attached It more space Is required) <br />City of South Bend is additional insured with respect to General Liability. <br />City of South Bend <br />1400 County City Building <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 />AUTHORIZED REPRESENTATIVE <br />t~rlts.atw. .ka z <br />I South Bend <br />ax- Email• <br />ACORD 26 (2016103) <br />YA%Aft 0_9IfAL• Annnn A.1. _1- <br />_ .___ _�.�..�.'. ... ��... �...-........ .... .new ...v...•c... <br />The ACORD name and logo are registered marks of ACORD <br />