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HomeMy WebLinkAboutPublic Parking Facility - 121 E. Wayne St., 109 W. Jefferson Blvd., 126 N. Main St. - LAZ1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS March 12, 2024 Mr. Alan Lazowski LAZ Parking Midwest, LLC 1228 N. Eddy St. South Bend, IN 46617 compliancemailklazparking com RE: Renewal of Public Parking Facilities License - 121 E. Wayne St., 109 W. Jefferson Blvd., 126 N. Main St. Dear Mr. Lazowski: At its March 12, 2024 meeting, the Board of Public Works approved the above referenced public parking facility licenses. Kindly update the current signage with your new City license numbers in accordance with Municipal Code Section 4-39: 121 E. Wayne St. — License #PBP2024-011 109 W. Jefferson Blvd. — License #PBP2024-010 126 N. Main St. — License #PBP2024-012 The Board has approved this license, contingent upon this remedy. Should you have any questions, please contact this office at (574) 235-9251. Sincerely, /s/ Theresa Heffner Theresa Heffner, Clerk Enclosures TH/lh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BRIANA N. MIcou INTEROFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 01/26/2024 TO: Jim Wood, Neighborhood Services and Enforcement Chris Dressel, Community Investment Gerard Ellis, Fire Department Kyle Ludlow, Engineering FROM: Theresa Heffner, Clerk SUBJECT: Annual License Application for Public Parking Facility LOCATION: LAZ Parking Indiana, LLC. 121 E. Wayne St., 109 W. Jefferson Blvd., 126 N. Main St. Public Parking Facilities are regulated by municipal code section 4-39. (Copy attached). Please review the attached public parking license application and provide your recommendations in the spaces below. NEIGHBORHOOD SERVICES AND ENFORCEMENT: Favorable COMMUNITY INVESTMENT: Favorable FIRE: Section 4-39(k) Favorable ENGINEERING: Section 4-39(b) Favorable Sec. 4-39. - Public parking facility. (a) Definition. Public parking facility shall mean any plot, piece or parcel of land or any building or structure used for the purpose of storing motor vehicles where the owners or persons storing such vehicles are charged a fee and which are open to the public. (b) Signs required: (1) Each licensee under this section shall maintain at each entrance to the licensed public parking facility a permanently affixed sign suitable to apprise persons using the public parking facility of the name of the licensee, the hours of the day or night during which such places are open for storing motor vehicles, the rates charged and the closing hours of such lot. (2) When more than one rate is charged for parking, the figures of each rate shall be of the same size and dimensions. The figures shall measure not less than eight (8) inches in height. The letters and figures indicating the closing hours shall not be less than four (4) inches in height. (3) The sign shall give the number of the City license under which the lot is operated. (4) Where the licensee operates a receiving lot in which cars are accepted with the understanding that such cars may be removed to another lot, the licensee shall post on such sign, in letters not less than four (4) inches in height, the following information: "Receiving Lot —Cars Parked Here May Be Moved To No. Street," (giving the address to which such cars are moved). (5) All signs shall be subject to the approval of the Building Commissioner of the City. (6) Where separate rates or charges are made for day parking and for night parking, notice shall be posted on the signs described in subsection (b)(1) of this section. (c) License required. No person shall maintain or conduct a public parking facility within the City without first having obtained the approval from the Board of Public Works and a license issued by the Controller. (d) Application: (1) Applications for licenses for public parking facilities shall be made by the person intending to operate a public parking facility. (2) The application shall set forth the following: a. The name under which and the place where the open parking lot is to be operated. b. Whether the applicant is an individual, partnership or corporation. If an individual, the name and business and residence address of the applicant shall be given; if a partnership, the name and business and residence address of each partner shall be given; if a corporation, the name, date and state under which such corporation was organized, and the name and business address, resident agent, and a certified copy of article of incorporation, if requested by the Board of Public Works, shall be furnished. c. Whether the premises are owned or leased by the applicant, and, if leased, the name and residence and business address of each owner, or part owner thereof. d. The number of motor vehicles which may, at any one time, be stored upon the premises. e. The hours during which motor vehicles may be stored. f. A complete schedule of the rates to be charged for storing motor vehicles and the hours at which changes in rate take place. g. Such other information as the Board of Public Works may deem advisable. (3) The application shall be signed and verified under oath by the applicant, if an individual, or by a duly authorized agent, if a partnership or corporation. (e) Public parking facility. A fee of eighty dollars ($80.00) shall be paid for each license issued under this section. (f) Bond or property liability insurance: (1) No license shall be issued pursuant to this section and public parking facility shall be operated until and unless the licensee under this section has deposited with the Board a bond or property liability insurance policy in the amount scheduled in this section. The bond or insurance policy shall be with one or more adequate sureties or a surety company acceptable to the Board and conditioned that the licensee will pay all final judgments rendered against him for damages arising during the period such bond or insurance policy is in force from the operation of the motor vehicle in such public parking facility, or from loss, damage, theft or conversion of any motor vehicle. (2) Any person who sustains damage by reason of the violation of any provision of such bond or insurance by a licensee may institute suit upon the same and recover any judgment that may be obtained by reason of such suit. (3) The bond or insurance policy shall meet the following requirements: a. It shall contain a provision that it shall continue in force until ten (10) days after written notice of cancellation has been delivered to the Board of Public Works or until the license of the applicant has been revoked. b. The obligation of the bond or insurance policy shall not exceed the principal amount of the bond. c. The bond or insurance policy shall be in the following amounts: 1. Where the licensee conducts one (1) lot, ten thousand dollars ($10,000.00). 2. Where the licensee conducts two (2) lots, fifteen thousand dollars ($15,000.00). 3. Where the licensee conducts three (3) lots, the sum of twenty thousand dollars ($20,000.00). 4. Where the licensee conducts four (4) or more lots, the sum of twenty-five thousand dollars ($25,000.00). (g) Investigation of applicants; issuance of license: (1) If, after investigation, the Board of Public Works determines that the applicant for a license meets the requirements of the section, the Board shall report the same to the Controller. (2) The Controller shall issue to the applicant a license for a public parking facility upon payment of the proper fee. (h) Claimchecks or tags: (1) At the time of accepting a motor vehicle for storage or parking in any public parking facility the person conducting the lot, or his agent, servant or employee, shall furnish to the person parking his motor vehicle a distinctive check. (2) The check shall be numbered to correspond to a coupon placed upon such motor vehicle and contain the name and address of the place and the owner operating such public parking facility. Upon such check shall be written, printed, cut out or stamped the date, and, if parking is charged for on an hourly basis, the time of acceptance of such motor vehicle. (3) The above provision shall not be applied where cars are stored on a monthly fee basis. (i) Rate changes: (1) No licensee under this section shall make any charge for storing any motor vehicle in a public parking facility in excess of that set forth in his application for a license, unless he has: a. Notified the Board of Public Works in writing of the change. b. Posted signs showing such change in the same manner as set forth in subsection (b). 0) Claims against lot; reports; liability after hours: (1) Each licensee under this section shall immediately notify the Controller of any claim over twenty- five dollars ($25.00) made by reason of any loss, theft or conversion occurring upon his premises or of any claim for damages arising from the operation of his public parking facility. (2) The obligation of any person operating or conducting a public parking facility under the terms of this section to the owner of a motor vehicle parked therein shall not extend beyond the regular posted hours of attendance, as posted upon the open parking lot and printed upon the regular receipt check furnished to the motor vehicle owner. (k) Fire equipment required; cars to be accessible: (1) Public parking facilities shall be equipped with proper fire extinguishing apparatus subject to the approval of the Fire Department. (2) All motor vehicles shall be stored in such a manner that they may be reached readily in case of fire or other emergencies. (1) Temporary lots; restrictions: (1) Nothing contained in this section shall be deemed to require the licensing of temporary lots operated for the accommodation of motorists attending public functions, such as football games or circuses, even though a fee may be charged the patrons of such temporary lots. No such temporary lots, however, shall be operated more than two (2) days in any week. (2) At the entrances of the temporary lots there shall be placed a sign on which is printed the words, in letters of sufficient size to be legible to all patrons "Temporary Parking Lot —Not Licensed." (m) Exemptions. All governmental owned and operated public parking facilities shall be exempt from the licensing provisions of this chapter. (Ord. No. 6998-81, § 1; Ord. No. 7723-86, § 2; Ord. No. 9093-00, § XII) For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 7.2310121 7 g��p ��.9 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal yes _ II. BUSINESS DATA A. Business Name: LAZ Parking Indiana, LLC B. Business Address: 109 W Jefferson Blvd City: South Bend ____State: IN a Zip:46601 C. Mailing Address (If different from above): 1 Financial Plaza, 14th Floor City: Hartford State: CT Zip: 06103 D. Business Telephone Number: 860-522-7641 E. Business Fax Number: F. E-Mail Address: compliancemail@lazparking.com G. Maximum Number of Vehicles that can be parked at facility at onetime: 500 H. Total Number of Parking Spaces at facility: 500 I. Hours during which vehicles may be stored: 24/7 H. Premises are (check one): Leased by Applicant Owned by Applicant Yes If Leased: Owner's Name: Owner's Business Address: City: Owner's Residential Address: Zip: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: For Office Use Only Application Filed JAN 2 5 2024 Public Works Approval Application Fee Paid JOIN US 2024 License Fee Paid 5 2024 Sent to Dept. J flN 2 3 2024 License Number P P9 9OA4 —C)! 0 Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS 1*1L4 Elizabeth A. Msradik, President 40.� Qs --Al Gary A. Gilot, Member Murray L. Miller, Member WE - Joseph R. Molnar, Vice President Briana Micou, Member Attest: Theresa M. Heffner, Clerk Date: Much 12, 2024 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: Alan Lazowski B. Residential Address: 170 Scarborough St City: Hartford State: CT C. Residential Telephone Number: 860-522-7641 ` D. Residential Fax Number: E. Cellphone Number: F. Position with Business: CEO Zip.. 06105 IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Yes Corporation (If corporation, proceed to 3). I. Sole Proprietor Name: Residential Address: City: Telephone Number: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: State: State: Zip: Zip: Name #2: Residential Address: City: State: Zip: Telephone Number: 3. Corporation Legal name of corporation: LAZ Parking Indiana, LLC Date and state of incorporation: 2 For all municipal business license questions, contact: City of South Bend - Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name. Alan Lazowski Title. Chairman/CEO Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Officers: Name #1: Jeffrey Karp Title: President/Secretary Business Address: 4 Copley Place City: Boston Residential Address: City: Nam, tp. Michael Kuziak Titl, COO Zip: 06103 te: MA Zip: 02116 State: Zip: Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Zip: 06103 Residential Address: City: State. — Nam, it -A. Nathan Owen Title, CEO Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Residential Address: City: State:_ a p: 06103 Zip: 3 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. �eQ.rL � �Gl.• Signature 21 01 /02/2024 Date �Vw.r ii►{�R W. '•�lf LEIGHTON PARKING GARAGE �- 109WJEFFERSON' DAILY RATES' 0 - 2 Hours $ FREE 2 - 3 Hours 4.00 ;7 al 3 5 Hours 6.00 5 - 8 Hours 8.00 8 - 24 Hours 10.00 - LOST TICKET = $10.00 ..... MONTHLY PARKING ` - STANDARD $55 I MONTH PARKING = RR5 RIVED! S90 1 MONTH RESIDENTIAL $401 MONTH -, f " PART TIME $35 1 MONTH 4;' ACCWE)� � CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifioate holder is an ADDITIONAL INSURED, the poll the terms and conditions of the policy, certain policies may require an end certificate holder in lieu of such endorsement(s). PRODUCER Brown 6 Brown of MA, LLC 500 Victory Rd. Marina Bay North Quincy MA 02171 INSURED Laz Parking Midwest, LLC 33 West Monroe Street Suite 2010 Chicago IL 60603 COVERAGES polio D BI L I TY INSURANCE DATE (MMIDD/YYYY) 1/3/2024 CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED must be endorsed. If SUBROGATION IS WAIVED, subject to orsement. A statement on this certificate does not confer rights to the c "MFrank Griffin NAME: PHONE (617)471-1220 /UAX C No: (617)479-5147 ADDRESS: frank. griffin@bbrown.com INSURERS AFFORDING COVERAGE NAIC 9 INsuRERA: Liberty Mutual Fire Insurance 23035 INSURERB:LM Insurance Corporation :33600 INSURERC: Berkley Insurance CompanyCoMpany 32603 INSURER D: HDI Specialt-Z Insurance ComDany 131 INSURERE ' federal Insurance Company '20281 INSURERF:Everest National Insurance Com an :10120 CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IIN POLICY NUMBER MMIDD jMMID0IYYYY1 GENERAL LIABILITY X COMMERCIALGENERALLIABILITY A CLAIMS -MADE a OCCUR 2611260451033 1/31/2029 !/31/2024 x Contractual Liability GEN'LAGGREGATE LIMITAPPLIES PER: POLICY X PRO. X LOC AUTOMOBILE LIABILITY A X ANYAUTO ALL OWNED SCHEDULED 2611260451013 /31/2023 7/31/2024 AUTOS AUTOS X HIREDAUTOS X AUTOSWNED X UMBRELLA LIAB X OCCUR EL ATTACHED LIST OF X. EXCESS LIAB CLAIMS -MADE OLICIES 7/31/2023 1/31/2024 DED RETENTION S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ NIA (Mandatory In NH) GID260451053 /31/2023 /31/2024 If yes, describe under DESCRIPTION OF OPERATIONS below A GARAGEKEEPERS LIABILITY s2611260451013 1/31/2023 /31/2024 C CRIME/EMPLOYEE DISHONESTY CR4500269226 /31/2023 r/31/2024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured with a waiver of subrogation in their favor for general liability, but only with respect to the operations of the named insured. M22121: 109 W Jefferson Blvd, South Bend, IN 46601 CERTIFICATE HOLDER CANCELLATION LIMITS EACH OCCURRENCE S 1,000,000 DAMAGE to R NTEp PREMISESen e 5 1,000,000 MED EXP (Any one son S EXCLUDED PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS •COMNOPAGG S 2,000,000 COMBINED SINGLE LIMIT 5,0000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ EACH OCCURRENCE S 100,000,000 AGGREGATE S 100,000,000 5 X WC STATU• OTH- TOW WITS E E.L. EACH ACCIDENT S 1,000,000 EL DISEASE - EA EMPLOYEE $ 11000,000 E.L DISEASE -POLICY LIMIT 5 1,000,000 $1,000,000 LIMIT $5.000,000 LIMIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Executive Director Venues Parks & Arts AUTHORIZED REPRESENTATIVE 301 S. St. Louis Blvd South Bend, IN 46617 - -� :Fallon Carey/FACARE I ACORD 26 (2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IIN POLICY NUMBER MMIDD jMMID0IYYYY1 GENERAL LIABILITY X COMMERCIALGENERALLIABILITY A CLAIMS -MADE a OCCUR 2611260451033 1/31/2029 !/31/2024 x Contractual Liability GEN'LAGGREGATE LIMITAPPLIES PER: POLICY X PRO. X LOC AUTOMOBILE LIABILITY A X ANYAUTO ALL OWNED SCHEDULED 2611260451013 /31/2023 7/31/2024 AUTOS AUTOS X HIREDAUTOS X AUTOSWNED X UMBRELLA LIAB X OCCUR EL ATTACHED LIST OF X. EXCESS LIAB CLAIMS -MADE OLICIES 7/31/2023 1/31/2024 DED RETENTION S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ NIA (Mandatory In NH) GID260451053 /31/2023 /31/2024 If yes, describe under DESCRIPTION OF OPERATIONS below A GARAGEKEEPERS LIABILITY s2611260451013 1/31/2023 /31/2024 C CRIME/EMPLOYEE DISHONESTY CR4500269226 /31/2023 r/31/2024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured with a waiver of subrogation in their favor for general liability, but only with respect to the operations of the named insured. M22121: 109 W Jefferson Blvd, South Bend, IN 46601 CERTIFICATE HOLDER CANCELLATION LIMITS EACH OCCURRENCE S 1,000,000 DAMAGE to R NTEp PREMISESen e 5 1,000,000 MED EXP (Any one son S EXCLUDED PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS •COMNOPAGG S 2,000,000 COMBINED SINGLE LIMIT 5,0000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ EACH OCCURRENCE S 100,000,000 AGGREGATE S 100,000,000 5 X WC STATU• OTH- TOW WITS E E.L. EACH ACCIDENT S 1,000,000 EL DISEASE - EA EMPLOYEE $ 11000,000 E.L DISEASE -POLICY LIMIT 5 1,000,000 $1,000,000 LIMIT $5.000,000 LIMIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Executive Director Venues Parks & Arts AUTHORIZED REPRESENTATIVE 301 S. St. Louis Blvd South Bend, IN 46617 - -� :Fallon Carey/FACARE I ACORD 26 (2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured with a waiver of subrogation in their favor for general liability, but only with respect to the operations of the named insured. M22121: 109 W Jefferson Blvd, South Bend, IN 46601 CERTIFICATE HOLDER CANCELLATION LIMITS EACH OCCURRENCE S 1,000,000 DAMAGE to R NTEp PREMISESen e 5 1,000,000 MED EXP (Any one son S EXCLUDED PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS •COMNOPAGG S 2,000,000 COMBINED SINGLE LIMIT 5,0000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ EACH OCCURRENCE S 100,000,000 AGGREGATE S 100,000,000 5 X WC STATU• OTH- TOW WITS E E.L. EACH ACCIDENT S 1,000,000 EL DISEASE - EA EMPLOYEE $ 11000,000 E.L DISEASE -POLICY LIMIT 5 1,000,000 $1,000,000 LIMIT $5.000,000 LIMIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Executive Director Venues Parks & Arts AUTHORIZED REPRESENTATIVE 301 S. St. Louis Blvd South Bend, IN 46617 - -� :Fallon Carey/FACARE I ACORD 26 (2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Executive Director Venues Parks & Arts AUTHORIZED REPRESENTATIVE 301 S. St. Louis Blvd South Bend, IN 46617 - -� :Fallon Carey/FACARE I ACORD 26 (2010106) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 25084 ACrpRp�° LOC#: Sae ACORD 25 %---- ADDITIONAL REMARKS SCHEDULE Pa e� of AGENCY NAMED INSURED Amity Insurance A Division of Brown & Brown of MA LLC PCUCY N UMEF,R See Certificate See ACORD 25 CARRIER NAIC CODE See Certillcate EFFECTIVE PATE: 713112023 ADOMONAL REMARKS THIS ADDITIONAL REMARKS FORM IS ASCHEOULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER G: American Guarantee & Llabllity Insurance Company 26247 INSURER H: Westfield Specialty Insurance Company 16992 INSURER I: Great American Assurance Company 26344 INSURER J: ADDITIONAL POLICIES IIf a policy below does not include limit Information, refer to the corresponding policy on the INSR I ADDL I SUBR I EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER DATE DATE (mm/ddtyW) (mm/d&/ W) certificate LIMITS IzA ;I=55 GENERAL D LIABILITY XLXD6109900S 7/31/2023 7/31/2024 AGGREGATE $4,000,000 E UMBRELLA LIABILITY 79863543 7/31/2023 7/31/2024 AGGREGATE $25,000,000 EXCESS LIABILITY F XC9EX00286231 7/31/2023 1 7/31/2024 AGGREGATE $15,000,000 G EXCESS LIABILITY AEC011173109 7/31/2023 7/31/2024 AGGREGATE $15,000,000 EXCESS LIABILITY " XSL345214K00 7/31/2023 7/31/2024 AGGREGATE $10,000,000 EXCESS LIABILITY I EXC5125913 7/31/2023 7/31/2024 AGGREGATE $10,000,000 E EXCESS LIABILITY 78187246 7/31/2023 7/31/2024 AGGREGATE $25,000,000 ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are reglstered marks of ACORD For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 aq 7 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal ye§ II. BUSINESS DATA A. Business Name: LAZ Parking Indiana, LLC B. Business Address: 1159 W deffelso., Blvd 1 a to m• m(�{l �ST City: South Bend State: IN Zip, 46601 C. Mailing Address (If different from above): 1 Financial Plaza, 14th Floor City: Hartford D. Business Telephone Number: 860-522-7641 E. Business Fax Number: State. CT Zip: 06103 F. E-Mail Address: compliancemail@lazparking.com G. Maximum Number of Vehicles that can be parked at facility at onetime: 500 H. Total Number of Parking Spaces at facility: 500 I. Hours during which vehicles may be stored: 2417 H. Premises are (check one): Leased by Applicant Owned by Applicant Yes If Leased: Owner's Name: Owner's Business Address: City: Owner's Residential Address: a City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: For Office Use Only Application Filed J AN 2 5 2024 Public Works Approval Application Fee Paid EIRZ4 License Fee Paid Sent to Dept, ORIM4 —License Number Q & Pgo VrOM CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved vjI,,4 Reason Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Q Gary A. Gilot, Member Briana Micou, Member Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: March 12, 2024 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: Alan Lazowski B. Residential Address: 170 Scarborough St City: Hartford -State: CT C. Residential Telephone Number: 860-522-7641 D. Residential Fax Number: E. Cellphone Number: F. Position with Business: CEO Zip: 06105 IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Yes Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: Telephone Number: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: Name #2: Residential Address: State: Zip: State: Zip: City: State: Zip: Telephone Number: 3. Corporation Legal name of corporation: LAZ Parking Indiana, LLC Date and state of incorporation: 2 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S *South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Name: Alan Lazowski Title: Chairman/CEO Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Zip: 06103 Officers: Name #1: Jeffrey Karp Title: President/Secretary Business Address: 4 Copley Place City: Boston State: MA 7ip7 02116 Residential Address: City: State: Zip: Name #2: Michael Kuziak Title: COO Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Residential Address: City: Name #3. Nathan Owen Title- CEO Zip: 06103 State: Zip: Business Address: 1 Financial Plaza, 14th Floor city: Hartford State: CT Zip. 06103 Residential Address: City: State: Zip: 3 For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION Vill. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. Signature 4 01 /02/2024 Date OPEWED BY MAIN STREET PARKING GARAGE NO DAILY RATES MONTHLY PARKING 0 - 2 Hours $ FREE STANDARD $55 / MONTH 2 - 3 Hours 4.00 PARKING 3 - 5 Hours 6.00 PREMIUM / $90 / MONTH RESERVED 5 - 8 Hours &00 RESIDENTIAL $40 /MONTH 8 - 24 Hours 10.00 PART TIME $35 / MONTH LOST TICKET = $10-00 ii ACC CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 6-.__✓ 1/25/2024 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 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Frank Griffin AX Brown & Brown of MA, LLC PHONE (617)471-1220 FMC. No (617)479-5147 500 Victory Rd. ADDRESS: frank.griffin@bbrown.com Marina Bay INSURER(SI AFFORDING COVERAGE NAIC # North Quincy MA 02171 INSURER A: Liberty Mutual Fire Insurance 23035 INSURED INSURERB:LM Insurance Corporation :33600 Laz Parking Midwest, LLC INSURER c: BerkleyInsurance Comnpany 32603 33 West Monroe Street INSURERD:HDI Specialty Insurance Company 16131 Suite 2010 INSURER E: Federal Insurance Company 20281 Chicago IL 60603 INSURER F: Everest National Insurance Company 10120 r]nVFRAr;FS CFRTIFICATF Nl1MRFR- REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IINSRR TYPE OF INSURANCE 4>DDL7�B2611260451033 POLICY NUMBER MM DDDPOLICY EFF POLICY EYXnP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AMA ENT PR 1 ES Ea occurrence $ 1,000,000 A CLAIMS -MADE � OCCUR 7/31/2023 7/31/2024 MED EXP (Any one person) $ EXCLUDED PERSONAL BADV INJURY $ 1,000,000 x Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY �[ PRO X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT JEaacrid 1 S 5,000,000 BODILY INJURY (Per person) $ A X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS RIX NON -OWNED HIREDAUTOS AUTOS I kS2611260451013 7/31/2023 17/31/2024 BODILY INJURY (Per accident) $ PPROPaE DAMAGE $ X UMBRELLA LIAB X OCCUR 3EE ATTACHED LIST OF EACH OCCURRENCE $ 100,000,000 AGGREGATE $ 100,000,000 �( EXCESS LIAB CLAIMS -MADE ?OLICIES 7/31/2023 ,7/31/2024 PED RETENTION S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A iA561D260451053 ,7/31/2023 .7/31/2024 x WT.0 STATU- OTH- Y R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L.DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below A GARAGEKEEPERS LIABILITY JiS2611260451013 7/31/2023 .7/31/2024 $1,000,000 LIMIT C CRIME/EMPLOYEE DISHONESTY 3CCR4500289226 7/31/2023 .7/31/2024 $5,000,000 LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured with a waiver of subrogation in their favor for general liability, but only with respect to the operations of the named insured. Re: 1422126 - 126 N. Main St, South Bend, IN 46601 CFRTIFIr_ATF Elul nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of South Bend, Indiana Attn: Executive Director Venues AUTHORIZED REPRESENTATIVE Parks & Arts 301 S. St. Louis Blvd South Bend, IN 46617 Fallon Carey/FACARE ACORD 25 (2010105) T ' 196d-ZUIU AS:UKU GUKFUKAI IUN. AU ngnis reservea. INS025 (201005)01 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 25084 --1 LOC #: See ACORD 25 A` OFiOr ADDITIONAL REMARKS SCHEDULE Page Of AGENCY NAMED INSURED .Amity Insurance A Division of Brown & Brown of MA LLC POUCYNUMBER Ise. Certificate See ACORD 25 CARRIER NAIC CODE :See certificate EFFECTIVE DATE 7fa VZ123 ADDITIONAL REMARKS ACORD 101 (2008/01) ®2008 ACORD CORPORATION AJI rights reserved The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 25084 LOC #: See ACORD 25 ADDITIONAL REMARKS SCHEDULE Paae of AGENCY NAMED INSURED Amity Insurance A Division of Brown 8 Brown of MA LLC IJGYNUMBER Certificate See Certificate See ACORD 25 F EXCESS LIABILITY XC9E02 X086231 7/31/2023 7/31/2024 AGGREGATE $15,000,000 G EXCESS LIABILITY AEC011173109 7/31/2023 7/31/2024 AGGREGATE $15,000,000 EXCESS LIABILITY R XSL345214K00 7/31/2023 7/31/2024 AGGREGATE $10,000,000 EXCESS LIABILITY I EXC5125913 7/31/2023 7/31/2024 AGGREGATE $10,000,000 E EXCESS LIABILITY 78187246 7/31/2023 7/31/2024 AGGREGATE $25,000,00 ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Payable To City of South Bend Address 227 west Jefferson Blvd Suite 1400 S city South Bend State IN Zip Code 46601 Check Amount: $ 255.00 Reason For Request: Date: 01 /02/2024 APPROVED By Jessica Hoxie at 8:30 am, Jan 03, 2024 Check Handling Instructions: ❑ Mail to Address ❑ Hold for Pick Up ® EFT Transaction ❑ Fed Ex Check p other_QO NOT SEND Compliance will mail Submitted By: Marisol Garcia Approved By: Heather Parker untNumber 1111 1 11 g Location 1 Amount i 11 �1 1111 see 7201251$85.00 11 1111 @ 11 720126 ', ; 11 Company Number Invoice Number Reference Check Number: Check Date: 3104 Accounting Use Only Vendor Number Invoice Date Dollar Amount Posted For all municipal business license questions, contact: City of South Bend - Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S *South Bend, Indiana 46601 - 574.235.5912 • F: 5 4.f99Aq 7�( LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal yes II. BUSINESS DATA A. Business Name: LAZ Parking Indiana, LLC f B. Business Address: `fi + � e- ;f1F�M' q3� City: South Bend State: IN ip• 46601 C. Mailing Address (If different from above): 1 Financial Plaza, 14th Floor City: Hartford State: CT Zip: 06103 D. Business Telephone Number: 860-522-7641 E. Business Fax Number: F. E-Mail Address: compliancemail@lazparking.com G. Maximum Number of Vehicles that can be parked at facility at onetime: 500 H. Total Number of Parking Spaces at facility: 500 I. Hours during which vehicles may be stored: 2417 H. Premises are (check one): Leased by Applicant Owned by Applicant Yes If Leased: Owner's Name: Owner's Business Address: City: Owner's Residential Address: Zip: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: For Office Use Only Application Filed JAIL 2 5 2024 Public Works Approval Application Fee Paid JAN 2 5 2024 License Fee Paid 4 � Sent to Dept. N2 la 2024 License Number 2) - QI CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved _ titia ��11 Reason Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A. Gint, Member Briana Micou, Member Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk Date: March 12, 2024 For all municipal business license questions, contact: City of South Bend - Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 III. PERSONAL DATA A. Applicant's Legal Name: Alan Lazowski B. Residential Address: 170 Scarborough St City: Hartford State: CT C. Residential Telephone Number: 860-522-7641 D. Residential Fax Number: E. Celephone Number: F. Position with Business: CEO Zip: 06105 IV. OWNERSHIP A. Type of ownership (check one): Sole Proprietorship (If sole proprietorship, proceed to 1). Partnership (If partnership, proceed to 2). Yes Corporation (If corporation, proceed to 3). 1. Sole Proprietor Name: Residential Address: City: State: Telephone Number: 2. Partnership (List at least two (2) partners) Name #1: Residential Address: City: Telephone Number: Name #2: Residential Address: State: City: State: Telephone Number: 3. Corporation Legal name of corporation: LAZ Parking Indiana, LLC Date and state of incorporation: Zip: Zip: Zip: 2 For all municipal business license questions, contact: City of South Bend - Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 IV. OWNERSHIP (Continued) A. Type of ownership (continued): 3. Corporation (continued) Resident Agent: Narne: Alan Lazowski Title: Chairman/CEO Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT zip: 06103 Officers: Name #1: Jeffrey Karp Title: President/Secretary Business Address: 4 Copley Place City: Boston State: MA Zip: 02116 Residential Address: City: Name #2: Michael Kuziak Title: COO Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Residential Address: City: Name #3: Nathan Owen Title: CEO Zip: Zip: 06103 State: Zip: Business Address: 1 Financial Plaza, 14th Floor City: Hartford State: CT Residential Address: City: 3 State: Zip: 06103 Zip: For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 V. INCLUDE COMPLETE RATE AND HOUR SCHEDULE WITH APPLICATION VI. INCLUDE A CURRENT INSURANCE POLICY OR BOND VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION VIII. AFFIRMATION I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Public Parking Facility license found in the City of South Bend Municipal Code, Section 4-39. Signature 01 /02/2024 Date 4 DAILY RATES 0 - 2 Hours 2 - 3 Hours $ FREE 3 - 5 Hours 4.00 5 - 8 Hours 6.00 8 - 24 Hours 8.00 10.00 ' LOST TICKET MONTHLY PARKING - STANDARD $55 1 MONTH PARKING PREMIUM / $901 MONTH �' RESERVED RESIDENTIAL $401 MONTH PART TIME . $351 MONTH �, i yL°'ra�a•'� II r ACC)REP CERTIFICATE OF LIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANI CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A 1 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IN1I'VK IAN T.' If the certificate holder is an ADDITIONAL INSURED, the poli the terms and conditions of the policy, certain policies may require an end certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown of MA, LLC 500 Victory Rd. Marina Bay North Quincy MA INSURED Laz Parking Midwest, LLC 33 West Monroe Street Suite 2010 02171 IL 60603 BI L I TY INSURANCE DATE (MM/DD/YYYY) 1/3/2024 I CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ;ONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED :y(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to arsement. A statement on this certificate does not confer rights to the CON ACT Frank Griffin NA ; PHONE (617)471-1220 FAX R!C No: (617)479-5147 ADDRESS- frank. griffin@bbrown. com INSURERS AFFORDING COVERAGE NAIC b INSURERA: Libert Mutual Fire Insurance 3035 INSURER B : LM Insurance Corporation :33600 INSURERc:Berkle Insurance Com an :32603 INStiRERD:HDI S ecialt Insurance Company . 6131 INSURER E : Federal Insurance Com an '20281 INsuReRF:Everest National Insurance Com an 10120 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. NTR TYPE OF INSURANCE ARDL SUB POLICY NUMBER MM DD1YEYYY MM1pp1YYYY GENERAL LIABILITY GENERAL LIABILITYACLAIMS-MADE OCCUR B2611260451033 /31/2023 1/31/2024 �XXVCOMMERCIAL ntractual Liability GEN'L AGGREGATE LIMIT APPLIES PER: POLICY51PECTRO- POLICY LOC AUTOMOBILE LIABILITY A X ANYAUTO ALL OWNED SCHEDULED 52611260451013 1/31/2023 1/31/2024 AUTOS AUTOS X HIREDAUTOS R AUTOS NON-O�ED LA OCCUR (9Z EXCESS ABIAB r� CLAIMS -MADEI I OLICIFSCHED LIST OF /31/2023 1/31/2024 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory In NH) 61D260451053 /31/2023 7/31/2024 If yes, describe under A JGARAGEKEEPERS LIABILITY I 2611260451013 �l/31/2023 +/31/2024 C CRIME/EMPLOYEE DISHONESTY cra45Da2ee226 IP/31/2023 /31/2024 LIMITS EACH OCCURRENCE s 1,000,000 AMAGE T NTED -PREMISES (El Mal S 1,000,000 MED EXP oneperson) S EXCLUDED PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOPAGG s 2,000,000 COMBINdED SINGLE LIMIT entl 5 000 ❑00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE P $ EACH OCCURRENCE $ 100,000,000 AGGREGATE $ 100,000,000 X WC STATU• 01H- S E.L EACH ACCIDENT S 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 LIMIT $5.000.000 LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space Is required) If agreed upon in a written contract or agreement, City of South Bend, Indiana is included as an additional insured with a waiver of subrogation in their favor for general liability, but only with respect to the operations of the named insured. Re: M22125: 121 E Wayne St, South Bend, IN 46601 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend, Indiana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Executive Director Venues Parks & Arts AUTHORIZED REPRESENTATIVE 301 S. St. Louis Blvd South Bend, IN 46617 Fallon Carey/FACARE I ACORD 26 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 25084 AC RO DA LOC #: See ACORD 25 lk� ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Amity Insurance A Division of Brown & Brown of MA LLC POLICY NUMBER !See Certificate See ACORD 25 CARRIER NAIL CODE Sae Certificate EFFECTIVE DATE: 7I31 190192 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance AFFORDING COVERAGE ' NAIC # INSURER G: American Guarantee & Liability Insurance Companv 26247 INSURER H: Westfield Spedalty Insurance Company 16992 INSURER I: Great American Assurance Company 26344 J: ADDITIONAL POLICIES It a policy below does not include limit information, refer to the Corresponding policy on the ACORD certificate form for policy limits INSR LTR TYPE OF INSURANCE ADDL SUBR INSD WVD POLICY NUMBER POLICY EFFECTIVE DATE (mmldd/ W) POLICY EXPIRATION DATE (mm/ddlm) LIMITS D EXCESS GENERAL LIABILITY XLXD6109900S 7/31/2023 7/31/2024 AGGREGATE $4,000,000 E UMBRELLA LIABILITY 79863543 7/31/2023 7/31/2024 AGGREGATE $25,000,000 F EXCESS LIABILITY XC9EX00286231 7/31/2023 7/31/2024 .AGGREGATE $15,000,000 G EXCESS LIABILITY AECO11173109 7/31/2023 7/31/2024 JAGGREGATE $15,000,000 " EXCESS LIABILITY XSL345214K00 7/31/2023 7/31/2024 AGGREGATE $10,000,000 I EXCESS LIABILITY EXC5125913 7/31/2023 7/31/2024 AGGREGATE $10,000,000 E EXCESS LIABILITY 78187246 7/31/2023 7/31/2024 AGGREGATE $25,000,000 ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD