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12/08/00 07:58 '$219 236 6399 GIBSON INSURANCE LvjDuf <br />ap= t <br />.� CERTIFICATE OF LIABILITY INSURANCE <br />DATE I1AWDD1YY) <br />I <br />1 12,pa,2000 <br />PRO""ER (E00)614-2122 FAX (219)236-6399 <br />GIBSON INSURANCE GROUP <br />P o Box 610, Plymouth IN 46 S 6 3 <br />or P 0 Box 11177 <br />South Bend, IN 46634-0177 <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />INSURED <br />G9neral Sheet Metal Works, Tnc. <br />1902 S Main Street <br />South Bend, IN 46613 <br />INSURF.RA' Indiana lnsuranGa Co. <br />1NGURERB: <br />INBURERC: <br />INSURERD: <br />INSURER E <br />COVERAGES <br />THE POLIOIEB OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I DILATED. NOTWITHS)" ING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, FYCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN RFDUCED BY PAID CLAIMS- <br />URANCE <br />POUCYNUM9ER <br />UATEIMMIDDlYY)- <br />DATE MMIDO(YY <br />LIMITS <br />LTR <br />rGENEPALLIAWLITY <br />ENERAL LIABILITYFIftE <br />DE = OCCUR <br />BP9379037 <br />01/01/2000 <br />U1/U1/2001 <br />tAIHUC[UHRtNIt 9 1.000,000 <br />DAMAGE (Arty,Sr\a fun) 3 S0,ODU <br />NtEU t7iY (nr,y os+e Q"r"°('1 <br />PERSONAL&ADV INJURY S 1,000.000 <br />A <br />GENERAL AGGREGATE d 21000,000 <br />PRODUCTS - COMPIOPAGG S 2.000.00c <br />GEN'L AGGREGATE UMrr APPLIES PER; <br />POLICY jFIQT X LOG <br />A9378837 <br />01/01/2000 <br />01/01/2001 <br />COMBINED SINGLE LIMIT <br />(Ea emdanQ 1,000,00 <br />AUTOMOBILE LIABILITY <br />Y ANY AUTO <br />ALL OWNED AUTOS <br />Bar INJURY <br />(Per PQraw) <br />SCHEDULED AUTOS <br />A <br />x HIRED AUTOS80DILY <br />INJURY 3 <br />IPer Bcm8m) <br />X NON.OWNED AUTO& <br />PROPERTY OAMAGC S <br />(per axldont) <br />AUTO ONLY - EA ACCIUEMT S <br />GARAGE LIABILITY <br />ANY AUTO <br />CA ACC <br />OTHER THAN <br />AUTO ONLY: AC 8 <br />3 <br />S <br />EXCESSLIABILTTY <br />X DccuR � CLAIMS 6AAD& <br />U9378537 <br />01/01/2000 <br />01/01/2001 <br />FACH OCCURRENCE 1 <br />s 5,000,00 <br />3 5 , 000 , 00 <br />_ <br />AGGREGATE <br />3 <br />A <br />s <br />DEDUCTIBLE <br />s <br />RETENTION G <br />WORKERS OOMPEN5ATION AND <br />EMpLOYERW UADIUTY <br />C 9 3 7 6 3 3 7 <br />01/01/2000 <br />01 / 01 / 2 0 01 <br />- <br />X TO M S ER <br />A <br />EL EACH ACCIDENT <br />EL DISEASE • CACMKO -- <br />E.L.OlGrzASE-POLICY 40MIY <br />3 100 , 00 <br />S 100,400 <br />a 500.001 <br />ADOMONAL INSURED; INSURER LETTER <br />v <br />City of south Bend <br />20S W. Jefferson Blvd. <br />South Bond. IN 46601 <br />SHOULD ANY OF THE ABOVE DESCR1a@O POLICIEta BE CANCEi-LED BEFpRETr16 <br />EXPIRATION DATE THEREOF, THE ISSUING COMPP'W %ILLENOF.AVQR TO tams. <br />n _ DAYS WFUTTEN NOTICE TO THE CERTLFICAT£ HOLLLEfr T, <br />BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO 05U041ION C t1 IaI:ILITY <br />OF ANY KIND UPON THE WMPANY, ITS AGENTS OR REPRESENTATIVL'$, <br />Iris A enc /CHRISS ��� <br />