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�e A CERTIFICATE OF LIABILITY INSURANCE DATE (MM/Y) 05/05/20232023 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 McGowan Insurance Group PO Box 6458 South Bend IN 46660 CONTACT RAY BARSON NAME: PHONE FAX No Ex , n c. Hoy: E-MAILrayb@rncgowaninsgrp.com ADDRESS: INSURER($) AFFORDING COVERAGE NAIC# INSURERA: Property Owners Insurance Company 32905 INSURED PEGGS Restaurant LLC 127 S Michigan St South Bend IN 46601-1907 INSURER B : INSURER C : INSURER D : INSURER E : INSURERF: 9-r%11=0ARCC (:FRTIFI(.ATF MHURFR• CL235556415 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. 1NSR I LTR TYPE OF INSURANCE flLUWL1bUbK )NSID WVD POLICY NUMBER POLICY EFF MM?DD1YyYY POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE � OCCUR PREMISES Ea 0=urrence S 300,000 MED EXP (Any one person) $ 10,000 A Y 09026221 06/01/2023 06/01/2024 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 JLOC POLICY ET Premises/Operations $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIM1T Ea amden! $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROP RTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/A A106594450 O6/01/2023 06I01/2024 PER OTH- STATUTE ER E.L. EACH ACCIDENT 100,000 $ E.L. DISEASE- EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT 500,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) City of South Bend is Additional Insured on General Liability- 30 day notice of cancellation applies CEKI IFIGAI t MULUEK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. Board of Public Works AUTHORIZED REPRESENTATIVE 227 W Jefferson Blvd Ste 1316 �pyy South Bend IN 46601y/,�ir U 19BB-ZU15 AGUKU GUKI-UKAI IUN. AU ngnis reserveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD