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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />03/21/2023 <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(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 <br />CONT <br />NA ACT Nora Grimm _ <br />Aldridge Insurance <br />PHONE jp� I, 5742328232 <br />1323 North Ironwood <br />E-MAIL <br />INSURER(S) AFFORDING COVERAGE <br />NAIC S <br />INSURERA: Adl ton/Roe & Co <br />000000 <br />South Bend IN 46615 <br />INSURED <br />INSURERS <br />INSURER C : <br />Bob Lyons <br />INSURER D: <br />52160 Woodsedge Or <br />INSURER E : <br />Granger IN 46530 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 />ILTIR NSR TYPE OF INSURANCE <br />ADD, <br />SUMWAD <br />POLICY NUMBER <br />POLICYEFF <br />POLICY EXP <br />LIMITS <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$1000000 <br />CLAIMS -MADE IxI OCCUR <br />Pp MEET EHENTEOn <br />S 100000 <br />MED EXP (An we Perim <br />s 1000 <br />PERSONAL &ADV INJURY <br />A <br />! Y <br />MSE023J4194 <br />09/11/2023 <br />10/11/2023 <br />S 1000000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />S 2000000 <br />X POLICV� ECT �LOC <br />& <br />PRODUCTS-COMPIOP AGG <br />OTHER: <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO <br />BODILY INJURY (Per Peman) $ <br />OWNED SCHEDULED <br />BODILY INJURY(PeracAderd) $ <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />PROPERTY DAMAGE S <br />AUTOS ONLY AUTOS ONLY <br />fPer aqQdentl <br />S <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE _ _ _ <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE s <br />S <br />DED RETENTION S <br />WORKERS COMPENSATION <br />PER T OTH. <br />E ER <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />(Mandatory in NH) <br />E.L. DISEASE -EA EMPLOYEE <br />S _ <br />If yes. describe under <br />DE SCRIPTIONOFOPERATIONSWI. <br />E.L. DISEASE -POLICY LIMIT <br />S <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AiNi timal Rene" Schedule, may be attached if more space Is r"ulred) <br />Certificate holder listed below is named as additional insured per attachedl. 820 <br />Attendance: 80, Event Type: Walking Event <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of South Bend, IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />Special Events Committee <br />' 227 West Jefferson Blvd, Room 732 AUTHORIZED REPRESENTATIVE <br />South Bend IN 46601 <br />=aX: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />