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4 <br />' a <br />ACORO CERTIFICATE OF LIABILITY INSURANCE <br />11 <br />DATE (MMMOIYYYY) <br />1 12/5/2023 <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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsements(. <br />PRODUCER <br />Mabel Beltran <br />Arthur J. Gallagher Risk Management Services, LLC <br />9155 South Dadeland Boulevard, Suite 1112 <br />Miami FL 33156 <br />PHDNE 786-337-1267 FAX <br />Mile, mabel belban a' .com <br />INSURE 8 AiFORDINGCOVEMOE <br />MAIC0 <br />INSURER A Philadelphia Indemnity Insurance Company <br />18068 <br />_ <br />M3M FOUREPI-03 <br />Fourth Episcopal District AME Church <br />Olivet AME Church <br />INSURER B. Technology insurance Company, Inc <br />42376 <br />INatIRER c <br />msU D: <br />719 N. Notre Dame Ave. <br />wau E: <br />South Bend IN 46617. <br />_ <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 1975989730 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 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />A <br />M <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEFP <br />POLICY <br />ILBTS <br />A <br />X COMMERCIALGENEMLLIA lL l <br />PHPK2629079 <br />121112023 <br />12/112024 <br />EACHOCCLIRRENCE <br />$1000000 <br />LWMS#UUE F—x1 OCCW <br />PREMIS n <br />f 100,000 <br />MED EXP (A,,INN <br />S 5,000 <br />PERSONAL S ADV INJURY <br />111,000,000 <br />_ <br />GENERAL AGGREGATE <br />f3. DO0.000 <br />GENT AGGREGATE LIMIT APPl1ES PER' <br />POLICY JJEGT � LOC <br />PRODUCTS COMPIOP AGG <br />f 3 000 000 <br />Sexual M,� <br />11.000.000 <br />X OTHER'. P IMmixi r <br />AUTOMOBILE LIABILITY <br />PHPK2829079 <br />12/1R <br />12/1/2021 <br />COMBINEDIHE LIMIT23 <br />$1,000,000 <br />BODILY INJURY (PIN qn n) <br />f <br />ANY AUTO <br />I <br />OWNED X SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY T. Amaanb <br />f <br />PROPERTY DAMAGEf <br />0.0 <br />HIRED NONOWNED <br />AUTOS ONLY AUTOS ONLY <br />f <br />A <br />(UMBRELLA LMB <br />X <br />OCCUR <br />PHUBS91054 <br />12/1/2023 <br />12/102024 <br />EACHOCCURENCE <br />$1,000.000 <br />AGGREGATE <br />f 1 000.000 <br />% <br />l EXCEaS LMa <br />CLAIMS -MADE <br />j DED <br />I I RETENTIONS <br />S <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y <br />ANYPROPRIETORIPARTHERlEXECUTME <br />KVVC133906A <br />12/1/2023 <br />12MI2024 <br />X TATIRE R <br />E.L EACH ACCIDENT <br />SI,D00,000 <br />RI OFFICEMEMBEREXCLUDED1 ❑ <br />IMAMMory In NH) <br />NIA <br />E.L. DISEASE - EAEMPLOYEE <br />$1,000,000 <br />if asama umAr <br />DESCRIPTION OF OPERATIONS tAMwv <br />E.L. DISEASE POLICY LIMIT <br />f 1 000 000 <br />A i DID "EPL <br />PHSDIS41376 12/1/2023 <br />12/1/2024 <br />OmoMme <br />Ag e Limn <br />RA <br />$1.000.000 <br />DAO57,S001EPUS15 <br />K <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES PICORD 101, Addiba l RsmAns fc ir. may p afbcM 11 man apsu b rpulrMl <br />Automobile coverage applicable to members vnth scheduled automobiles on file With company All affiliated members receive Hired and Na1-0wrled Autos <br />coverage. <br />Claims Made coverage for D80, EBL and EPL. Ratio Dale: 12/1/2014 <br />Sexual Misconduct Liability is excluded in the Excess Liability policy. <br />Evidence of insurance <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATRJN DATE THEREOF. NOTICE WILL BE DELIVERED IN <br />Olivet AME Church ACCORDANCE WITH THE POLICY PROVISIONS. <br />719 N. Notre Dame Ave. <br />South Bend IN 46617 AUTHORD:EDREPRESENTATIVE <br />USA <br />A n - <br />01988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />