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AC R V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) llft� 06/09/2022 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 have ADDITIONAL INSURED provisions or 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 CONTACT Jessica Bender NAME: Synergy LLC PHONE 574 231-6566 FAx 574 258-9177 13800 Jackson Road E-MAIL clservioe s ner insurance rou com ADDRESS: Y gY g p- INSURER S AFFORDING COVERAGE NAIC # Mishawaka IN 46544 INSURER A: SOCIETY INS GROUP 15261 INSURED INSURER B: Haunt of Hounds LLC INSURER C : DBA Fatbird INSURER D : 103 W Colfax St INSURER E : South Bend IN 46601 INSURERF: COVERAGES rFRTIFIr ATF NI IMRFR• ors�ic �n� uii iaadctr. 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 TYPE OF INSURANCE POLICY EFF POLICY EXP JLTR POLICY NUMBER M/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE NIOCCUR EACH OCCURRENCE $ 1,000,000 REMISES(Ea occ rienit6 $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 A BP2007879 07/1/2022 07/1/2023 �GENT AGGREGATE LIMIT APPLIES PER: POLICY PE� 1-1 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS BP20007879 7/1/2022 7/1/2023 BODILY INJURY (Peraccident ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE P r aceldanl $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE UM20007881 7/1/2022 7/1/2023 DED I X I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER ANYPROEXCLUDED?ECUTIVE ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC20007880 7/1/2022 7/1/2023 X STATUTE EOrH E.L.EACH ACCIDENT $ 500,000 E,L. DISEASE - EA EMPLOYEE $ 500,000 EL. DISEASE - POLICY LIMIT $ 500,000 A Cyber & Privacy Liability CY20007882 07/01/2022 07/01/2023 $ 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Board of Public Works- City of South Bend is listed as additional insured on general liability. JUN 13 2022 City of South Bend Div. of Engineering CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 227 West Jefferson 1316 County -City Building AUTHORIZED REPRESENTATIVE South Bend IN 46601lca, q., l✓ir+lt ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD