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ACQ 2/2/2024
<br />V CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
<br />��.
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER M NA Frank Griffin
<br />Brown & Brown of MA, LLC PHONN (617)471-1220 FlaNo, (617)479-5147
<br />M. 500 Victory Rd. ADDRESS: frank. griffin@bbrown.com
<br />Marina Bay INSURER(S) AFFORDING COVERAGE NAIC #
<br />North Quincy MA 02171 INSURER A: Liberty Mutual Fire Insurance 23035
<br />INSURED INSURER B: LM Insurance Corporation 33600
<br />Laz Parking Midwest, LLC INSURER C: BerkleyInsurance Company 32603
<br />33 West Monroe Street INSURERD:HDI Sp2CililtY Insurance Company 16131
<br />Suite 2010 INSURER E: Federal Insurance Company 20281
<br />Chicago IL 60603 INSURER F: Everest National Insurance Company 10120
<br />rnlioonr_cc rCDTICIrATF wIMRFR• REVISION NUMBER:
<br />THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW SAVE 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 MAYBE 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 />IINSR
<br />ADDLISUBRI
<br />POLICY FfF
<br />LIMITS
<br />LTR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />MMLODYM'YY
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />T
<br />PREMISES Ea rren
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ EXCLUDED
<br />A
<br />CLAIMS -MADE FX] OCCUR
<br />3B2611260451033
<br />7/31/2023
<br />7/31/2024
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />% Contractual Liability
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />06LI Y X FARO- X LOC
<br />JECTCOMBINED
<br />AUTOMOBILE LIABILITY
<br />SINGLE LIMIT
<br />Ea acci n
<br />$ 5,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />A
<br />ANYAUTO
<br />INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />15 2611260451013
<br />7/31/2023
<br />7/31/2024
<br />AUTOS AUTOS
<br />X X NON -OWNED
<br />PROPERTY
<br />Peac TY DAMAGE E$
<br />HIRED AUTOS AUTOS
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />3EE ATTACHED LIST OF
<br />EACH OCCURRENCE
<br />$ 100,000,000
<br />X
<br />AGGREGATE
<br />$ 100, 000, 000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />?OLICIES
<br />7/31/2023
<br />7/31/2024
<br />DED RETENTION $
<br />B
<br />WORKERS COMPENSATION
<br />R WC S7ATLI- OTH-
<br />TORY LIMITS
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE jet I
<br />E.L, EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? I`� I
<br />(Mandatory in NH)
<br />NIA
<br />�A561D260951053
<br />d/31/2023
<br />7/31/2024
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 11000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />GARAGEKEEPERS LIABILITY
<br />1S2611260451013
<br />d/31/2023
<br />7/31/2024
<br />$1,000,000 LIMIT
<br />C
<br />CRIME/EMPLOYEE DISHONESTY
<br />3CCR4500289226
<br />7/31/2023
<br />7/31/2024
<br />$5,000,000 LIMIT
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />If agreed upon in a written contract or agreement, Ciyt of South Bend, Indiana is included as an
<br />additional insured for general liability, but only with respect to the operations of the named insured.
<br />L22124: Corby's Lot Matthews 2 - 430 E Lasalle Ave South Bend, IN 46617. Parking Spaces 25
<br />/�G OTI CIf�ATC -^I mom UAIUUl 1 A1111N
<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 />Ciyt of South Bend, Indiana
<br />Attn:
<br />Executive Director Venues
<br />AUTHORIZED REPRESENTATIVE
<br />Parks
<br />& Arts
<br />301 S.
<br />St. Louis Blvd
<br />South
<br />I
<br />Bend, IN 46617
<br />Fallon Carey/FACARE
<br />ACORD 25 (2010/05) W tsnn-tU IU 711,%JMU PV-1 U.
<br />INS025 (201005)01 The ACORD name and logo are registered marks of ACORD
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