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A V F02/14/14CERTIFICATE OF LIABILITY INSURANCE DAT//2025 Y) <br />025 <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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER NAME: CertlflcateDepartment _ _ <br />PHONE 574-544-2874 -j,vC, Noy 574-544-2874 <br />Priority Risk Management Arc No. Ex ; <br />PO Box 2379 ADDRESS: certs0priorityriskccom <br />INSURERIS) AFFORDING COVERAGE NAIC # <br />South Bend IN 46680 INSURER A: FRANKENMUTH MUT INS CO 13986 <br />INSURED INSURER B <br />Fiddler's Hearth, Inc. INSURER C <br />127 N Main Street INSURER D : <br />INSURER E : <br />South Bend IN 46601 INSURER F: <br />COVERAGES CERTIFICATE NUMBER: <br />THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED P <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DO( <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEI <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM <br />S TYPE OF INSURANCE INSO WVA POLICY NUMBER MWDDrYYYY) I lmmcorYYYY) <br />LTR <br />�( COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />A <br />Y <br />6605292 <br />09/11/2021 <br />09/18/2025 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO ❑ LOC <br />JECT <br />OTHER: <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />A <br />OWNED gCHEDULED <br />6605291 <br />09/18/2024 <br />09/18/2025 <br />AALL <br />UTOS <br />,ON -OWNED <br />X HIRED AUTOS X AUTOS <br />Liquor Liabilit <br />X UMBRELLA LIAR X OCCUR <br />A <br />EXCESS LIAB CLAIMS -MADE <br />6605292 <br />09/18/2024 <br />09/18/2025 <br />DED X I REIENIION S 10,000 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />A <br />ANY PROPRIETOPIPARTNERIEXECUTIVE <br />OFFICERlMEMBEREXCLUDED7 ❑N <br />NIA <br />6605290 <br />09/18/2024 <br />09/18/2025 <br />(Mandatorytn NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />A <br />Liquor Liability -Occurrence Limit <br />6605292 <br />09/18/2024 <br />09/18/2025 <br />A <br />Liquor Llability-Aggregate Limit <br />6605292 <br />09/18/2024 <br />09/18/2025 <br />DESCRIPTION <br />OF OPERATIONS I LOCATIONS / VEHICLES <br />(ACORD <br />101, Additional Remarks Schedule, may <br />be attached If more <br />space Is regl <br />CERTIFICATE HOLDER CANCELLATION <br />REVISION NUMBER: <br />UMENT WITH RESPECT TO WHICH THIS <br />tEIN IS SUBJECT TO ALL THE <br />TERMS, <br />LIMITS <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES Ea occumenca <br />$ 500,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000. <br />Es accident <br />$ 1,000,00O <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />MAIM PSracGdenl} <br />$ <br />EACH OCCURRENCE <br />$ 3,000,000 _ <br />AGGREGATE <br />$ 3,000,000 <br />X I STATi}TE ER <br />_ <br />E.L. EACH ACCIDENT <br />$ 500,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 500,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 500,000 <br />$1,000,000limit <br />$2,000,000 limit <br />Ired) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of South Bend <br />125 S Lafayette Blvd Ste 100 AUTHORIZED REPRESENTATIVE <br />South Bend IN 46601 c +!► %/!. [A� <br />1988-2014 ACORD CORPORATION. All rights <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />