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re <br />L <br />ACIII CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMMDNYYY) <br />5/19/2023 <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(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 hostler in lieu of such andorsement(s). <br />PRODUCER <br />Gibson Insurance Agency Inc <br />202 South Michigan St., Suite 1400 <br />South Bend IN 46601 <br />INSURED <br />Mind Body Spirit Solstice Festival <br />Jamila Blue <br />South Bend IN <br />COVFRAC-PS r.FRTIFIr:ATF NUMIRFR•2n93?4..VM REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE 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 />rNfR <br />TYPE OF KBIIRI111GE <br />wee <br />.1 <br />POLICY NUM <br />POLICY EFF <br />OLICY <br />LVoorrOP <br />LIMAS <br />A <br />COUNUUtCWLGFDERALUAeLrTY <br />PHPK250227T <br />1/12023 <br />1/1/2024 <br />EADH OCCURRENCE <br />S1,000,000 <br />CLAMS -MADE I) OCCUR <br />PREA11 S Ee <br />S10D.000 <br />X <br />NED EXP tti <br />SExcluded <br />PERSONAL S ADV INJURY <br />$1.000,000 <br />OENL AGGREGATE UNIT APPLIES PER <br />GENERALMXIREOATE <br />62,000,000 <br />PRODUCTS-COfPIOPAGO <br />S2,000,000 <br />POLICY El� El LOC <br />i <br />OTHER <br />AUTOMORLELNESUrrY <br />f <br />BODILY KIURY(Par paean) <br />S <br />ANY AUTO <br />BODLYINAMCY(Pwa=Mw* <br />f <br />OWNED !X]IEDUIED <br />AUTOS ONLY _ <br />AUTOS ONLY AU10.4 My <br />pROpERf1,DAW19E <br />$ <br />S <br />UMBRELLAl1As <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />S <br />j "CEBDLW <br />CLAWS.NppE <br />DEO I I RETENTION <br />S <br />WORMERS COMPENSATION <br />AND EMPLOYERS' UJUSILRY YIN <br />ANYPROPRIETORIPARTNERIEXECUTIVE <br />EL REIiT EACH ACC <br />f <br />E.L 019EA8E-EA <br />S <br />OFFICERAIEMSEREXCUUDEDi ❑MIA <br />(111an4may In NH) <br />E.L DEiEASE-FOLIC'/ LYR <br />$ <br />N yee, dscrbo under <br />DESCRIPTION OF OPERATIONS Dhow <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, MdxbLW RpLurb ScIM4YN, mry M MCAM Imora Ar�xa Ir rpulrvtl) <br />RE: Memorial Day Parade 5-29-23 <br />The City of South Bend is additional insured with regard to general liability. <br />RE: 6-24-23 Mind Body Spirit Solstice Festival <br />The City of South Bend is additional insured with regard to general liability. <br />rcwTLCLr ATE HOLDER CANCFLLATION <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 />City Of South Bend Venues Parks & Arts <br />321 E Walter St <br />South Bend IN 46614 <br />AUTHOR�OREPREBENTATNE <br />�ibsnn � �nna�yL-c _�jr�n.l <br />® 186B-2U1 a ACVKU L:V KI'VKA L IVK. IVL ngma reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />