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ACCIPREP CERTIFICATE OF LIABILITY INSURANCE DATE <br />003/13/220 3� <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(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). OONT <br />PRODUCER NA EACT Brandy Shotts-Jay <br />Brandy Shotts E M. 217-251-4043 FAX <br />No: <br />McCammon Agency Corp ADDRESS: brandys@mccammonagency.com <br />PO Box 418 INSURERS AFFORDING COVERAGE NAIC t <br />Cloverdale, IN 46120 INSURER A: Hastings Mutual <br />INSURED INSURER B : <br />National Pavement Maintenance LLC JINSURER <br />1928 N Campbell Ave JINSURIER <br />Indianapolis, IN 46218 IINSURER <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED LU 1 HE INZSUMt:U NAMMU Aavvc rvr% inc: ru.+v� <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 />ITRR <br />A <br />TYPE OF <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />ADDL <br />I <br />x <br />SUER <br />POLICY EFF POLICY EXP <br />POLICY NUMBER M <br />6165438 08/10/2022 08/10/2023 <br />LIMITS <br />EACH OCCURRENCE <br />$ 1000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1000,000 <br />MED EXP (Any one person) <br />$ 5+� <br />PERSONAL & ADV INJURY <br />$ 1000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS -COMP/OP AGG <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- LOG <br />COMBINED SINGLE LIMIT <br />$ <br />1,000,000 <br />AUTOMOBILE LIABILITY <br />Ea accident <br />BODILY INJURY (Per person) <br />$ <br />A <br />ANY AUTO <br />X ALL OWNED SCHEDULED <br />AUTOS AUTOS NON -OWNED <br />X HIRED AUTOS AUTOS <br />x <br />6185615 03/12/2023 03/12/2024 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />A <br />X <br />UMBRELLA LIAR <br />EXCESS LIA6 <br />OCCUR <br />CLAIMS -MADE <br />x <br />6290555 <br />07/29/2022 <br />07/29/2023 <br />EACH OCCURRENCE <br />$ 3,000,000 <br />AGGREGATE <br />$ 3,000,000 <br />WC SLIMITTATUO R <br />$ <br />DED RETENTION $ <br />WORKERS COMPENSATION <br />EL EACH ACCIDENT <br />$ <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />OFFICERIMEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N/A <br />F-L DISEASE - POLICY LIMIT <br />$ <br />IT yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLtb (Anacn ACunv w i, Auumuna, --n— ,, -- a,........-.-n-..--, <br />TE HOLDER <br />City of South Bend <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 />Brandy Shotts-Jay <br />ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reservea. <br />The ACORD name and logo are registered marks of ACORD <br />