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Sidewalk Cafe - Hammer & Quill - 613 E. Jefferson Blvd.
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Sidewalk Cafe - Hammer & Quill - 613 E. Jefferson Blvd.
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Last modified
7/21/2025 12:45:44 PM
Creation date
4/22/2025 2:51:10 PM
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Board of Public Works
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Recommendations
Document Date
4/22/2025
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iMMIMM <br />ACC VI <br />CERTIFICATE OF LIABILITY INSURANCE DAo 12112025�' <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 POUCIES <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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorseme s . <br />PRODUCER CONTACT David GileS <br />The Leadership Insurance Agency, Inc. =lie Fill; 574-277-1611 FAx �; [574)2734557 <br />52303 Emmons Road 11AM L • Leadership@leadershipins.com <br />Suite 31 INSU S AFFORDING COVERAGE NAIC 0 <br />South Bend IN 46637 INSURER A: AUTO -OWNERS INS CO 189M <br />INSURED • — -- INSURER B <br />The General Deli LLC <br />609 E Jefferson Blvd <br />South Bend IN 46617 INSURER <br />^^%JcnAr00 !`CDTICIf`ATC hUNRARFr7- RFVI-CICIN NIIMRFR' <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />_EXCLUSIONS <br />IN5R LTA <br />TYPE OR INSURANCE <br />AOE]L <br />aR <br />POLICY <br />r'o"CYEFF <br />POLICYE%P <br />LIMITS <br />COKMERCIHLGENERAL LIABILITY <br />EACH OCCURRENCE <br />S 1000000 <br />- - — <br />CLNMS4AADE I � t l OCCUR <br />s 300000 <br />PR I IRS E a N EO rtco <br />$ 10000 <br />N ED EXP I am parson <br />PERSONAL s ADV INJURY <br />S 1000000 <br />A <br />Y <br />N <br />09013483 <br />1=912024 <br />10109/2025 <br />GEN'L AGGREGATE LW IT APPLIES PER. <br />GENERAL AGGREGATE <br />S 2000000 <br />PRODUCTS -COMPIOPAGG <br />E 20D0000 <br />POLICY 2) JEC LOC <br />$ <br />OTHEFt <br />AUTONIOSII.E IJAUFI-ITY <br />COMawm SINGLE LIMIT <br />y <br />BODILY INJURY (Per person) <br />S <br />ANY AUTO <br />BODILY INJURY (Per nco-doM) <br />$ <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />e' a <br />$ <br />---- <br />S <br />UMBRELLA L AS <br />OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />EXCESS LIAR <br />CLAIMS MADE <br />$ <br />_-'- <br />DF,n RETENTIONS <br />$ _ <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE Y� <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA A <br />OTH- <br />STA ER <br />S <br />E.L EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYE <br />S _ <br />F-L DISEASE - POLICY LIMIT <br />S <br />n yyeeaa tioeonbo urWar <br />DESCREPTION OF OPERATION$ below <br />Each Occurence <br />1000000 <br />A <br />Liquor Liability <br />N <br />N <br />09013463 <br />10/09/2024 <br />10/09/2025 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add] [ton nI Ramerks Behadukh may be after"Ir mots apace Is required) <br />City of South Bend is additional insured with respect to General Liability. <br />P`AKWCi 1 A7YAal <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of South Bend <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />1400 County City Building <br />AUTHORIZED TTATWE + <br />I South Bend IN 46601 <br />l-ax: t:maw (1r17}N6U-ZI1,10 ALUnU "Unrumm Iluln. All nynrs rca,:rVVU. <br />ACORD 2512016103) The ACORD name and logo are registered marks of ACORD <br />
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