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IErie <br />Insurance° <br />100 Elie Ins. PI. • Erie, PA 16530 <br />CERTIFICATE OF INSURANCE <br />-THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY. <br />CERTIFICATE HOLDER COPY <br />NAME AND NUMBER OF AGENCY <br />DATE ISSUED <br />SALINAS INSURANCE AGENCY INC <br />FF3134 <br />04/14/2024 <br />928 S MAYFLOWER RD STE B <br />SOUTH BEND, IN 46619-3949 <br />574-404-6767 <br />NAME AND ADDRESS OF CERTIFICATE HOLDER <br />NAME AND ADDRESS OF NAMED INSURED <br />CITY OF SOUTH BEND - PUBLIC WORKS <br />TX CONCRETE LLC <br />DEPT <br />24899 FILLMORE RD <br />1316 COUNTY CITY BLDG <br />SOUTH BEND IN 46619-1022 <br />SOUTH BEND IN 46601- <br />This Is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued. <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE'DATE <br />POLICY <br />EXPIRATION DATE <br />LIMITS OF INSURANCE <br />GENERAL LIABILITY <br />r0291821177 <br />05/18/2024 <br />05/18/2025 <br />EACH OCCURRENCE <br />$1000000 <br />FIRE DAMAGE <br />$1000000 <br />-COMMERCIAL GENERAL LIABILITY <br />OCCURRENCE FORM <br />(Any one premises) <br />GENL AGGREGATE LIMIT APPLIES <br />PER: PROJECT <br />MED EXP(Any one person) <br />$5000 <br />PERSONAL B ADV INJURY <br />$1000000 <br />GENERAL AGGREGATE <br />$2000000 <br />PRODUCTS-COMP/OP AGG <br />$2000000 <br />BODILY INJURY <br />$ <br />(EACH PERSON) <br />BODILY INJURY <br />$ <br />(EACH ACCIDENT) <br />PROPERTY DAMAGE <br />$ <br />BODILYINJURYAND <br />S <br />PROPERTY DAMAGE <br />COMBINED <br />EXCESS LIABILITY <br />Q291870273 <br />05/18/2024 <br />05/18/2025 <br />EACH OCCURRENCE <br />1000000 <br />OCCURRENCE FORM <br />AGGREGATE <br />2000000 <br />STATUTORY <br />- <br />�> <br />BODILY ACCIDENT <br />INJURY DISEASE <br />BY DISEASE <br />Fn='H nac^-EnT <br />S Paucr umrt <br />S EACHEMPLaYEE <br />DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />�_ <br />-- ---- - RECOVER' <br />AAf i mu <br />= r• LVLI <br />city of south 8eno <br />DIV of Enginleeftnq <br />CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and <br />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 <br />THIS CERTIFICATE IS ISSUED FOR INFORMATION PURPOSES ONLY AND <br />CONFERS NO RIGHTS ON THE CERTIFICATE HOLDER. IT DOES NOT <br />AFFIRMATIVELY OR NEGATIVELY LIST, AMEND, EXTEND, OR OTHERWISE ALTER <br />THE TERMS, EXCLUSIONS AND CONDITIONS OF INSURANCE COVERAGE <br />CONTAINED IN THE POLICY(IES) INDICATED ABOVE. THE TERMS AND <br />CONDITIONS OF THE POLICY(IES) GOVERN THE INSURANCE COVERAGE AS <br />APPLIED TO ANY GIVEN SITUATION. LIMITS SHOWN MAY HAVE BEEN REDUCED <br />BY CLAIMS PAID. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A <br />CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE <br />OR PRODUCER AND CERTIFICATE HOLDER. <br />OF-1568 09/12 CIF <br />ERIE INSURANCE <br />SEE REVERSE SIDE <br />AUTHORIZED l / <br />REPRESENTATIVE <br />