Permit - Public Parking Facility -Laz Parking - 121 S Niles & 1228 N Eddy

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DATE (MMIDDIYYYY) .aco�lo CERTIFICATE OF LIABILITY INSURANCE 12/20/2024 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 CONTACT NAME: Susie Guarino McGriff Insurance Services LLC PHONE 150 S. Warner Road, Suite 460 _w(,c • 61D-233-4846 FAX A c, Noi: King Of Prussia PA 19406 ADDRESS: Susan. uarinD m riff.com INSURER A: National Union Fire Ins Co of Pitt. PA 19445 INSURED 151LAZKARP INSURERB: AIU Insurance Company 19399 LAZ Parking Midwest, LLC - Chicago INSURER C : Allianz Global Risks US Insurance Co 35300 33 W. Monroe St., Suite 2010 Chicago IL 60603 INSURERD: INSURER E INSURER F : LI/^A = eu uA000. eno na agc RFVISIAN NIIMRFR- THIS IS TO CERTIFY THAT THE 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. MSR DL:S BR POLICY EFF POLICY P LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY Y Y 3609369 7/31/2024 7/31/2025 EACH OCCURRENCE $1,000.000 F-,7 CLAIMS -MADE OCCUR 11AME TO RENTED PREMISES xwrrence $ 1.000,000 IVIED EXP (Any one person) $ 10.000 PERSONAL &ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2.00%000 POLICY L jE O LOC $ OTHER: A AUTOMOBILE LIABILITY Y Y 3135689 7/31/2024 7/31/2025 COMBINED SINGLE LIMIT Ea accldmfi $5,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE er ate _ $ $ C X UMBRELLA LABX OCCUR Y Y SEE SCHEDULE 7/31/2024 7/31/2025 EACH OCCURRENCE $100,000.000 X AGGREGATE $ 100,000,000 EXCESS LIAB CLAIMS -MADE DE.D 1 1 .RETENTION $ $ B WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE Y WC014111735 7/31/2024 7/31/2025 XR STATUTEER E.L. EACH ACCIDENT $ 1,000,000 EL, DISEASE - EA EMPLOYE $ 1,000,000 OFFICER/M EMBER EXCLUDED? NJ N /A (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ 1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below A Garagekeepers Liability Y Y 3135689 7/31/2024 7/31/2025 11.000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) IF agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured with a waiver of subrogation in favor for general liability, but only with respect to the operations of the named insured. RE: L22137 — Emporium Lot —121 N Niles Ave. rco-rivif-ATC Wnt ntcp CANCELLATION City of South Bend 227 W. Jefferson Blvd, Suite 1400 S., South Bend IN 46601 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V lVtftf-ZUIOAGUKU LoUKrUKP1I Ivry. /All ngnw reaerveU. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD