Special Event - Bacon Around the Bend - June 24

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�Rd CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/1312023 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 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 GIBSON INSURANCE AGENCY, INC. (SOUTH BEND, IN) 202 S Michigan Street, Suite 1400 South Bend, IN 46601 CONTACT NAME PHONE (A/C No, Ext): FAX (A/C No): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED FAMILY JUSTICE CENTER OF ST. JOSEPH COUNTY 533 N NILES AVE SOUTH BEND, IN 46617 INSURER A: Mount Vernon Fire Insurance Company 26522 INSUREB B: INSURER C: INSURER D: INSURER E: INSURER F: CUVtt1AGE5 CERTIFICATE NUMBER' REVISION NUMBER' 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 LTR TYPE OF INSURANCE ADDL INSR SUBR MO POLICY NUMBER POLICY EFF (MMIDO/WW)(MMIODMIYY) POLICY EXP LIMITS GENERAL LIABILITY EEAACCHHGOECCCURENCE 1=000 X COMMERCIAL GENERAL LIABILITY SE 2016174 6/24/2023 S/26/2023 PREMISEMENTE.0 ce, $100,000 A CLAIMS -MADE ff] OCCUR MED EXP(Anyane person) $1,000 PERSONAL S ADV INJURY $1,000.000 GENERAL AGGREGATE $3.000." GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTSCOMPIOP AGO See LS35 E AUTOMOBILE LIABILITY CDMBIN MPINGLE LIMIT 'BODILY $ ANY AUTO A�BWNED SCyEDULED INJURY (Per person) $ BODILY INJURY (Par axidem$ HIREODSBAUTOS AAAUU%-JWNED pR�PPEEQ?AMAGE 1IF 11 $ E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DIED I I RETENTION E $ WORKERS COMPENSASION AND EMPLOYERS' LIABILITY ApN�Y CPROPREIE�ATgOERR/PARTNER/EXECUTIVE YIN ( .Fltl.E yln NHl EXCLUDED? ❑ 11IffMaass ae pb�e �nHd'er DSCRYf1S'['ON OF OPERATIONS below NIA Y FA TORY LIMMM FA E.L. EACH ACCIDENT E E.L. DISEASE -FA EMPLOYEE $ E.L. DISEASEPOLICY LIMIT $ A Liquor Liability BE 2016174 &24/2023 fi/26/2023 LID EA COMMON CAUSE $1,000,000 LIQUOR AGGREGATE $3,000,00p DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (See attached A=d 101 far addaional Iiabildy $mpi) City of SauN Bend is an additional insured per CG 20 26 N 13LA20 lV18 Specal Events Blanket Additional Insured Endorsement Is part of this pollcy.LJ820 1018 Spe I Events Blanket Additional Insured Endorsement m pan W this paliq.L-820 12118 Special Events Blanket Additional Inmred Endorsement is pan of Nis paltry. FI H of South Bend W Jefferson Blvd h Bend, IN 46601 L� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The ACORD name and logo are registered marks Of ACORD reserved.