My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
Special Event - Leeper Park Art Fair-June 13-16 2025
sbend
>
Public
>
Public Works
>
Board of Works Documents
>
2025
>
Licenses & Permits
>
Special Event - Leeper Park Art Fair-June 13-16 2025
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
7/21/2025 12:56:08 PM
Creation date
4/22/2025 2:51:22 PM
Metadata
Fields
Template:
Board of Public Works
Document Type
Recommendations
Document Date
4/22/2025
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
13
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
Show annotations
View images
View plain text
Firefox <br />about:blank <br />• <br />.0%+ <br />A60,Ro" CERTIFICATE OF LIABILITY INSURANCE <br />0320° 5"' <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: tithe certificate hold" is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />N 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 endorsement(s). <br />PRODUCER <br />CAW"T Candy Sullivan <br />PHONE AX <br />c <br />Banc Insurance Agency, Inc <br />E MMUL csullivan(idvlsuarNxAeisle.mn <br />67 Hunt Street <br />-ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />MAICa <br />Ste. 203A <br />M PJRERA: Ohio SecurRy lOSUCEnce Company <br />24082 <br />Agawam MA 01001 <br />]INSURER <br />INSURER B: <br />INSURERC: <br />St. JOG Watercolor Society <br />INSURER D: <br />54991 Willow Creek Dr <br />NSURER E <br />:SURER F: <br />Mishawaka IN 46545 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER' <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 REOUIREMENT, 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. <br />TYMOFMSURAMCE <br />POLICY MUYBER <br />MIYY <br />11Rf <br />A <br />X <br />COYYERCNLGEMERAL LIABIITY <br />CUJMS�E O OCCUR <br />Y <br />BLS59616886 <br />3/182025 <br />3/182026 <br />EACH OCCURRENCE <br />S 1,000,000 <br />i 300,000 <br />EE <br />MEO EXP(AM Pm perPpn) <br />i 15.000 <br />I <br />PERaoNALAAnvlwuar <br />a 1,000,000 <br />GENIAGOMMTELMUAPPUESKR <br />X POLICY❑jE �LOC <br />OTHER' <br />GENERAL AGGREGATE <br />S 2,000,001) <br />PRODUCTS - COMPIOP AGO <br />s 2,000,ODO <br />$ <br />AUTOMOBILE <br />!LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />ei <br />g <br />BODILY INJURY (Per Parson) <br />S <br />BODILY INJURY (Per accbanU <br />S <br />PROPERTY OAMAG <br />Par ac <br />S <br />S <br />UYBRP I•LIAB <br />EXCESS LIAR <br />OCCUR <br />CLNN9-MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />i <br />DED I I RETENTIONS <br />S <br />W ORXERS COYPENSILTN)M <br />ANDEMPLOYERS-MBILITY YIN <br />�CERR//IARIFM8ER"CLUDEUy�OUTIVE ❑ <br />(ManMRRy m NH) <br />If yes Oe5aI0e Unifier <br />DESCRIPTION OF OPERATIONS be. <br />MIA <br />STATUTE <br />E.L EACH ACCIDENT <br />s <br />EL DISEASE -EA EMPLOYEE <br />S <br />E.L DISEASE -POLMY UNIT <br />S <br />DESCRIPTION OF OPERATIONS I LOUTIONS I VEHICLES (ACORD 101, Mddmml Rem s schOuk, may W *MO O A nmm space u ma d) <br />The Ceri ficate Holder is named as addil onal Insured With respect to General Liability, <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />The City Of South Bend ACCORDANCE WITH THE POLICY PROVISIONS. <br />227 W. Jefferson Blvd. <br />South Bend IN 46601 <br />G 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORO 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />I Of I <br />3/27/2025, 4:27 PM <br />
The URL can be used to link to this page
Your browser does not support the video tag.