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Public Parking Facility - 121 E. Wayne St., 109 W. Jefferson Blvd., 126 N. Main St. - LAZ
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Public Parking Facility - 121 E. Wayne St., 109 W. Jefferson Blvd., 126 N. Main St. - LAZ
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4/17/2025 10:09:25 AM
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3/12/2024 2:49:47 PM
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Board of Public Works
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Recommendations
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3/12/2024
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ACC)REP CERTIFICATE OF LIA <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANI <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A 1 <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IN1I'VK IAN T.' If the certificate holder is an ADDITIONAL INSURED, the poli <br />the terms and conditions of the policy, certain policies may require an end <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Brown & Brown of MA, LLC <br />500 Victory Rd. <br />Marina Bay <br />North Quincy MA <br />INSURED <br />Laz Parking Midwest, LLC <br />33 West Monroe Street <br />Suite 2010 <br />02171 <br />IL 60603 <br />BI L I TY INSURANCE DATE (MM/DD/YYYY) <br />1/3/2024 <br />I CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />;ONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />:y(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to <br />arsement. A statement on this certificate does not confer rights to the <br />CON ACT Frank Griffin <br />NA ; <br />PHONE (617)471-1220 FAX <br />R!C No: (617)479-5147 <br />ADDRESS- frank. griffin@bbrown. com <br />INSURERS AFFORDING COVERAGE <br />NAIC b <br />INSURERA: Libert Mutual Fire Insurance <br />3035 <br />INSURER B : LM Insurance Corporation <br />:33600 <br />INSURERc:Berkle Insurance Com an <br />:32603 <br />INStiRERD:HDI S ecialt Insurance Company <br />. 6131 <br />INSURER E : Federal Insurance Com an <br />'20281 <br />INsuReRF:Everest National Insurance Com an <br />10120 <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 CONTRACTOR 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 />NTR TYPE OF INSURANCE ARDL SUB POLICY NUMBER MM DD1YEYYY MM1pp1YYYY <br />GENERAL LIABILITY <br />GENERAL LIABILITYACLAIMS-MADE OCCUR B2611260451033 /31/2023 1/31/2024 <br />�XXVCOMMERCIAL <br />ntractual Liability <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY51PECTRO- <br />POLICY LOC <br />AUTOMOBILE LIABILITY <br />A X ANYAUTO <br />ALL OWNED SCHEDULED 52611260451013 1/31/2023 1/31/2024 <br />AUTOS AUTOS <br />X HIREDAUTOS R <br />AUTOS <br />NON-O�ED <br />LA <br />OCCUR (9Z <br />EXCESS ABIAB r� CLAIMS -MADEI I OLICIFSCHED LIST OF /31/2023 1/31/2024 <br />B WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? N / A <br />(Mandatory In NH) 61D260451053 /31/2023 7/31/2024 <br />If yes, describe under <br />A JGARAGEKEEPERS LIABILITY I <br />2611260451013 �l/31/2023 +/31/2024 <br />C CRIME/EMPLOYEE DISHONESTY cra45Da2ee226 IP/31/2023 /31/2024 <br />LIMITS <br />EACH OCCURRENCE s <br />1,000,000 <br />AMAGE T NTED <br />-PREMISES (El Mal <br />S 1,000,000 <br />MED EXP oneperson) <br />S EXCLUDED <br />PERSONAL & ADV INJURY <br />S 1,000,000 <br />GENERAL AGGREGATE <br />S 2,000,000 <br />PRODUCTS - COMPIOPAGG <br />s 2,000,000 <br />COMBINdED SINGLE LIMIT entl <br />5 000 ❑00 <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />P <br />$ <br />EACH OCCURRENCE <br />$ 100,000,000 <br />AGGREGATE <br />$ 100,000,000 <br />X WC STATU• 01H- <br />S <br />E.L EACH ACCIDENT <br />S 1,000,000 <br />E.L DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 LIMIT <br />$5.000.000 LIMIT <br />S 1,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space Is required) <br />If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an <br />additional insured with a waiver of subrogation in their favor for general liability, but only with <br />respect to the operations of the named insured. <br />Re: M22125: 121 E Wayne St, South Bend, IN 46601 <br />CERTIFICATE HOLDER <br />CANCELLATION <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, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Executive Director Venues <br />Parks & Arts AUTHORIZED REPRESENTATIVE <br />301 S. St. Louis Blvd <br />South Bend, IN 46617 <br />Fallon Carey/FACARE <br />I <br />ACORD 26 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br />INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD <br />
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