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L;UYNt-S <br />TE CERTIFICATE OF LIABILITY INSURANCE D 02/21/20 3 <br />oz/zlrzaz3 <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 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 440-461-1101 DNeCT Sara Kollm <br />Todd Assoc, an ALERA Group Co. PHONE 440-461-1101 FAX 440-446-0192 <br />23825 Commerce Park, Suite A nJc, No, EM : ArC No): <br />Beachwood, OH 44122 P4•reaa , S O m to assoc[a S.com <br />Randy J. Cumley <br />INSURED <br />14 <br />LLC <br />F: <br />American Casualty Cd./CNA 120427 <br />Continental Insurance Co. 135289 <br />C0VFRAnFS r r-PTIF'If`ATC All IR1IClC17• MM2101^ka iii in.nr.ra. <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 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 />INSR TYPE OF INSURANCE ADDL SUBR: POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br />A X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE (� OCCUR <br />i6045941$$0 <br />02/14/2023 <br />02114/2024 <br />EACH OECURRENCE <br />D,NuWtnG£ TO RENTED <br />S9L6ES.[Ee oer�/mencal <br />1,000,00a <br />500,OOa <br />MED EXP fAny oneperson) <br />S 15,00a <br />PERSONAL &ADV INJURY <br />1,600,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />C3EN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- <br />JECT LOC <br />PRODUCTS - COMP/OP AGG <br />S 2,000,000 <br />OTHER. <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />._ E)li accident), <br />BODILYINJURY Per erson <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />E <br />BODILY INJURY Per accident <br />AUTOS ONLY AUTOS ONLY <br />met`_QANf4GE <br />$ <br />B <br />X <br />UMBRELLA LIAR X <br />OCCUR <br />EACH 0 CURRENCE <br />S 2,000,000 <br />AGGREGATE <br />s 2,000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />6045941913 02/14/2023 02/14/2024 <br />ME DTX1 RETENTION$ 10,000 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandel" in NH) <br />If yes, describe under <br />N / A <br />PER 0714- <br />STATUTE ER <br />$ <br />EL EACH ACCIDENT <br />_E L DISEASE - EA EMPLOYEE <br />J <br />DESCRIPTION OF OPERATIONSDPEMTIONS below <br />E L DISEASE - POUCY LIMIT <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />RE: 123 N Main St, South Bend, IN 46601 <br />CITYSOB <br />City of South Bend <br />Michelle Adams <br />Business License Administrator <br />227 W. Jefferson Blvd. <br />TION <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 />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />