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A�'® DATE (MMIDDIYYYY) CC CERTIFICATE OF LIABILITY INSURANCE 03/17/25 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 ri hts to the certificate holder in lieu of such endorsements). PRODUCER CONTACT NAME: ROCKSTROH INSURANCE AGENCY INC (A1CAQ Erct1:_(574)233-5136 _j c,Hgp; (574)232-2991 E-MAIL 333 N Lafayette Blvd ADDRESS:._rockagcy5@outlook.com South Bend, IN 46601-1208 INSURER(S) AFFORDING COVERAGE NAICA INSURED South Bend Cinco Lj-C DBA Cinco 5 112 W Colfax Ave INSURERA: Auto Owners Insurance ^ INSURERS: INSURER C : INSURER O : INSURER E: I-nVFRAGFS CFRTIFICATF NUMBER REVISION NUMRFR- 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. P'Sq�--- I EFF _ EXP — -- -ILTTYPE OF INSURANCEADDL-SUBR POLICY NUMBER MM ICY LIMITS--�� POI �Y xi — I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i S 1,000,000 _ CL AI645•A1ADE X OCCUR bAMAGE TO RENTED PREMISES (Ea occurrenceJ_ S _ - -- 50,000 AIE_OEXP(Anyoreperson] _,-9 5,000 A _ Y 09150919-24 1 O/16124 10116/25 PERSONAL A ADV INJURY_ 1 $ - 1 000,000 GGEN'L AGGREGATE LIIJIT APPLIES PER. GENERAL AGGREGATE I_S 2,000,000_ - —j JE _ 2,00,000 0 !X POLICY T I LOC PRODUCTS-COMPIOPAGG S ----" ... OTHER. I S AUTOMOBILE LIABILITY _-- COMB-NEO SINGLE LIMIT S (Ea acodentl"—, ANY AUTO SONLY INJURY (Per person) 5 OV,'*,ED SCHEDULED BODILY INJURY (Per a=dent) S. ._, AUTOS ONLY AUTOS _�-. —..._�._ HIRED NON -OWNED PROP�RWbA- AdE__ t S AUTOS ONLY , � AUTOS ONLY ,.(Per accidenlj UM1I13RELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UAB _ CLAIMS -MADE �DED 1 AGGREGATE RE TENTION9 WORKERS COMPENSATION PFR OTH- ANDEMPLOYERS' LIABILITY YIN -STATUTE _FR I ANY PROPRIETORrPARTNER EXECUTIVE - Et.EACHA000'-NT S OFFICER/1JEMBER EXCLUDED? NIA ❑ ('--- "---"--"— - - - - (Mandatory in NH) ! E L. DISEASE - EA EMPLOYEE S II yes, descrbe Under DESCRIPTION OF OPERATIONS below - El DISEASE - POLICY LIMIT S I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlttortal Remarks Schedule, may be attached if more sp— is requlred) Additional Insured - City of South Bend rFRTII=IrATI= Hr]I r1GR CANCFI I ATICIIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Board of Public Works THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1316 County City Building ACCORDANCE WITH THE POLICY PROVISIONS, 227 W Jefferson Blvd AUTHORIZED REPRESENTATIVE South Bend, 1N 46601 -, J--. U 1980-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD