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Home My WebLink AboutTransient Merchant License - St. Joseph County 4-H FairINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: 4/30/2025 TO: Chris Dressel, Community Investment Derek Erquhart, Fire Department Brad Rohrscheib, Police Department FROM: Theresa Heffner, Clerk theffner@southbendin.gov SUBJECT: TRANSIENT MERCHANT LICENSE RENEWAL RECOMMENDATION APPLICANT: St. Joseah Countv 4-H Fair LOCATION: 5117 Ironwood South Bend, IN 46614 DATE OF EVENT: June 27, 2025 — July 5, 2025 PLEASE INSERT YOUR RECOMMENDATION IN THE APPROPRIATE FIELD BELOW, BASED ON THE FOLLOWING ORDINANCE CRITERIA (sec. 4-60): Community Investment: Favorable Recommendation Police: Favorable recommendation Fire: Favorable recommendation For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 West Jefferson Blvd a Suite 1400 S -South Send, Indiana 46601 • 574.235.5912 • f: 574.23S.9021 cy, 3)b LICENSE APPLICATiQN FOR — TRANSIENT MERCHANT MUNICIPAL CODE SECTION - 4-60 I. APPLICATION TYPE Check One New Renewal x II. BUSINESS DATA A. Name of Event: St. Joseph County 4H Fair B. Business Name: St. Joseph County 4-H Fair, Inc. C. Business Address: 5117 S. Ironwood City: South Bend State: IN D. Mailing Address (if differs): Zip: 46614 City: State: Zip: E. Business Telephone Number: 574-291-4870 F. Business Fax Number: NIA & E-Mail Address: managers@4hfair.com H. Indiana State Retailer License number: 00431352$4000 I. Proposed location where business will be conducted: Total grounds 1. Description of building or premises to be used: K. Proposed Dates of Operation: June 27-July 5, 2025 L. Proposed Hours of operation: 7arrr11pm M. Types of goods to be sold: -Fair food, crafts, Carnival rides N. Scales will be used in business transactions: Yes No If yes, please attach certificate from the Sealer of Weights and Measures. O. Food will be served in ready -to -eat condition: Yes x No P. Description of nature of proposed advertising: Radio, Intemet,TV, Newspaper For Office Use Only Application Filed APR 3 a 2025 Public Works Approval Application Fee PaidAPR 3 TM License Fee Paid __ 0 2025_ Sent to Dept. !_ APR 3 4 2975 License Number MAOA5- CO-3 CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved �� 2 Reason Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R. Molnar, Vice President Breana Micou, Member 6;, Attest: Theresa M. Heffner, Clerk Date: June 10, 2025 For all municipal business license pue skin, mntad: MaSouM Bend • BepanmemnfCommunity Investment 227 We Ueffenon Bled • Suite I400S -South Bend, Indiana 46a01 a 574.235.59U • F. 574.235.Wa LICENSE APPLICATION FOR -TRANSIENT MERCHANT MUNICIPAL CODE SECTION -4-60 II. BUSINESS DATA(Continued) Q. Contact person to be responsible for customer complaints and available at least sizty(60) days following last date of business: Contact's Legal Name' Kristen Sikorski-Conklin Residential Address: City: South Bend State: IN zip NOW - Telephone Number: 574250-5086 III. PERSONAL DATA (Applicant) A. Applicant's Legal Name: Kristen Sikorski-Conklin B. Residential Address: City. South Bend State: IN Zip: C. Residential Telephone Number: NIA D. Cellphone Number: E. Position with business: Fair Board President F. Social Security Number: G. Gender H. Date of birth: I. Race: IV. PERSONAL DATA (Owner, if differs) A. Owner's Legal Name: _ B. Residential Address: City: State: Zip: C. Residential Telephone Number: D. Cellphone Number: E. Position with business: F. Social Security Number: G. Gender: H. Date of birth: 1. Race:. 2 For all munldpal business license 4uenions, contact: Cdy of South Bend • Department of community Investment 227WeztleRerson Blvd • Suite 3400S •Soudn Bend Indana 4K01 •524.235.5912 • F:5)4.335.%21 LICENSE APPLICATION FOR -TRANSIENT MERCHANT MUNICIPAL CODE SECTION -4-60 V. PERSONAL DATA (Additional Owner, if applicable) A. Owner's Legal Name: B. Residential Address: City: C. Residential Telephone Number: D. Cellphone Number: E. Position with business: F. Social Security Number: G. Gender: H. Date of birth: I. Race: VI. INCLUDE $5.00 PROCESSING FEE WITHAPPLICATION VIL INCLUDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF ALL GROUP EVENTPARTICIPANTS. Vill. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED AS THE CERTIFICATE HOLDER. IX. 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 noway attempted to mislead the City in this application by omitting facts known tome. I understand that the completed application must be filed no later than thirty days before the planned event is to begin. I have read and understand the regulations of the Transient Merchant license found in the City of South Bend Municipal Code, Section 4-60. 411b1� Signature Date Sarah and the Two Girls Farm Sarah Smith 1983 N 300 West Phone: 574-239-5319 Rochester, IN 46579 Author Stephanie Scott 509 5 Byrkit St. Mishawaka. IN 46544 Phone: 574-208-8898 Dr Vegetable Joshua Nicholson P.O. Box 528 Valparaiso IN 46383 Phone: 219-464-3123 A P Concessions Kristen Pacifico 18660 River Estate Ln Alva, FL 33920 Phone: 239-851-3397 Bruce's Concessions Jeffrey W. Bruce 802 South Church Street Hastings MI 49058 Phone: 269-838-5731 Bobcat of Michiana/Hull Lift Truck Attn: Caitlyn Wenger, Bobcat Sales Coordinator 28747 Old US Hwy 33 Elkhart IN 46516 Phone: 574-584-7590 Wakarusa Ag Attn: Dwayne Martin 711 East Waterford Street Wakarusa IN 46573-9573 Phone: 574-862-1163 Norwex/Creative Memories Kay Crum 613 Misty Harbor Court Mishawaka IN 46544 Gems of Pride Shaina Poland 4313 Windsor South Bend, IN 46619 Lakeville Lions Jim P.O. Box 506 Lakeville IN 46536 Phone: 574-259-7356 Cell: 574-5144344 Phone: 574-319-4916 Phone: 574-360-5705 C & C Concessions, Inc. Jason Colglazier P.O. Box 309 New Carlisle IN 46552 Phone: 574-654-8751 Coalbush United Methodist Church Michelle Wells 15977 Jackson Rd MishawakalN 46544 Phone: 574-259-4136 Fire N The Hale Wood Fired Pizzas Stacy Reed 5389 E 1000 5 Claypool IN 46510 Phone: 574-268-8306 Gideons International Jeffrey MCWhirt PO Box 1643 Mishawaka IN 46546 Phone: 574-259-5891 Everdry Waterproofing Attn: Julie A. Escalante 4647 W. Cleveland Road South Bend IN 46628 Phone: 574-272-3788 Clara Ross "Bubbles The Clown" 726 Cushing Street South Bend IN 46628 Phone: 574-520-0397 Food Court Concessions Bob Powell 11319 Iis Court Plymouth IN 46563 Phone: 574-780-0038 Kenay Arts Jahn C Harlan 3159 N Springfield Chicago IL 60628 Phone: 773-803-9187 Jake's Foods, LLC lay G Rounds 16075pringbrook Ct Phone: 574-238-3295 Goshen IN 46528 Trade/Midway Bobcat of Michiana Caitlyn Chupp 28747 Old US Hwy 33 Elkhart, IN 46516 Phone: 574-584-7590 Allen Feeds Lalon Allen 607 W Main St. North Manchester, IN 46962 Gloria Schrock Forte Enterprises (Tupperware) 22250 Ireland Road South Bend IN 46614 McKinney Food Service Shawn McKinney 3290 FM 161 N Hughes Springs TX 75656 Snowba Steven Towers 12482 Shearwater Run Fort Wayne IN 46845 Michiana Lawn Equipment Ron Holderbaum 919 East Mishawaka Road Elkhart IN 46517 Richard Ramirez Navajo Horse Hair Pottery 24250 Roosevelt Road South Bend IN 46614 Parnell Foods Brett Ruben 1101 North Ave Belvidere IL 61008 Phone: 260-982-7910 Henna Art Design layshree Patel 52076 Myrtle Ave South Bend, In 46637 McGrotha Foods Phone: 574- Brad McGrotha 305 Chamie Drive Thomasville GA 31792 Bohemian Beverage Co Erin Grigsby 11351 Shady Lane Drive Plymouth, In 46563 Phone: 903-237-9863 Phone: 574-274-4416 Phone: 574-295-5555 Coalbush United Methodist Church Dave Davenport 15977 Jackson Rd. Mishawaka, IN 46544 George's Fun Food Richard George P.O. box 420 Gibsonton, FL33534 Phone: 574-289-4179 Phone: 815-222-1142 Phone: 574-276-7320 Phone: 813-846-4032 Burnips Kyle Bontrager 66400 IN 331 Wyatt,IN 46595 Indiana National Guard Sgt. Kyle Statham 1023 West Edison Mishawaka IN 465" Penn Township 4-H Booth Joyce Schultz 2809 Northwood Mishawaka IN 46545 MISS Enterprise Chaudhry Sattar 19634 Rolling Acres Drive South Bend IN 46614 Crumb) Cookie Erycka Upowski 1290 E Ireland Rd South Bend, IN 46614 Rodney & Usa Ltd, LLC Rodney Albers P.O. Box 1435 Newcastle OK 73065 Great Lakes Concessions, LLC Nedderman Concessions FBA Southwest Soda Saloon -Dawn Welch Craig Nedderman Akron, OH 44306 Phone: 330-990-7803 17111 Jackson Rd South Bend, IN 46614 Phone: 574-273-8708 Phone: 229-221-5399 Phone: 574-540-6424 Phone: 574-633-4115 Phone: 574-323-3650 Phone: 574-876-6721 Phone: 574-329-1855 Phone: 574-318-7300 Phone: 405-387-3886 Phone: 574-286-4689 Francisco Rivera Puerto Vallarta Express 415 North Hickory Road Nelson's Port -A -Ph South Bend, Indiana 46615 Phone: Luis Espinosa, Tad Gongwer 574-322-1624 607 Nelson's Parkway Wakarusa IN 46573 Phone: 574-862-2184 Natalie Hume Quick Draw Caricatures, I.I.C. 2700 Poinsettia Avenue Middleburg FL 32068 Indiana Health Centers Miranda Bueno 1901 Western Avenue, Suite B South Bend, Indiana 46619 St. Joseph County Democratic Party Mary to Sullivan 135 South Lafayette Boulevard South Bend IN 46601 St. Joseph County Republican Party Susan Baxmeyer Box 245 South Bend IN 46624 Star Martial Arts McLane Birky 123 N. Elkhart Ave Elkhart IN 46516 Debra S. Berndt tills Rose 63476 Pierson Road Cassopolis, Michigan 49031 Newton Park c/o Marge Skaggs/Kevin Christy PO Box 449 Lakeville IN 46536 Moonlight Crystals/Minerals Tabitha Klimpel 2431 Flint Ct. South Bend, IN 46628 J & C Concessions Candace Van Wyk 4295 E Fenwicc Rd Fenwick, MI 48834 Phone: 419-217-6759 Phone: 574-234-9033 Phone: 574-229-6426 Phone: 574-299-1388 Phone: 74-522-5425 Phone: 269-445-3010 Phone: 574-274-9502 Phone: 702-327-5916 Phone: 989-576-4154 Pat Dykes Yoder Buildings, LLC 552 South Washington Street Valparaiso IN 46383 Phone: 219-405-5284 St. Joseph County Dairy Association Becky Freeman 13800 New Road Mishawaka IN 46544 Phone: 574-524-7069 The Donut Family Todd Hawkins 445 Lake Ave St Paul MN 55110 Phone: 651-398-5527 La Chica Store LLC Fatima Morales 56540 Woodbine LN Elkhart, IN 46516' Phone: 574-849-1655 Michelle Mayer Sir Home Improvements 22849 North US. 131 Highway Schoolcraft MI 49087 Phone: 269-447-3030 Tabitha Caid Scentsy 305 E. Michigan St Three Oaks M149128 Phone: 269-449-7565 Laura Brewer Pink Zebra & LipSense 1100 East Lake Street Knox, Indiana 46534 Phone: 574-806-8321 Pink Zebra Julie Reed 1245 Thorn Rd Walkerton, IN 46574 Phone: 574-514-5698 Cutco Attn: Janet"Wlggy" Wiggins Phone: 260-570-0054 E-Mall: jwiggins@cutcorep.com Weaver Outdoors Adam Weaver 52345 State Hwy 933 South Bend, IN 46637 Phone: 574-272-4242 Right to Life Michiana Jay Burke, Program Manager 2004 Ironwood Circle, Suite 130 South Bend IN 46635 Phone: 574-232-5433 The Pretzel Wagon Sue Miller 11797 Harder Three Rivers MI 49093 Phone: 269-625-0966 Michiana Lawn & Garden Ron Holderbaum 919 East Mishawaka, IN 46517 Phone: 574-295-5555 Thirty -One Gifts Kim Johnson 7752 N Mohawk Trail PO Box 265 Rolling Prairie IN 46371 Phone: 219-778-4523 Outlaw Roasted Corn Leo Vazquez 35015 Division Wyoming, MI H B Royalty Victor Berinstany 58025 County Rd 9 Elkhart, IN 46517 Lemonade N More Grant Ryals PO Box 2339 Riverview, FL 33568 R C Sales & Leasing Rick 23247 US 33 Elkhart, IN 46517 Slushie Station Blake Ryals PO Box 2339 Riverview, FI 33568 Phone: 616-218-5495 Phone:574-265-9742 Phone:813-460-1033 Phone:574-206-5153 Phone:813-460-2264 Tom's Tasty Taters Wayne Smith 809 Pearl St Plymouth IN 46563 Phone: 574-936-9672 Knights Of Columbus Steve Sommers 60750 Green Ridge Ct South Bend, IN 46614 Phone: 574-220-1212 LeafFilter North of Michigan, LLC 1595 Georgetown Road Hudson OH 44236 Phone: 800-726-7703 EA. 2305 NWI Portables Buildings/Yoders Bldg. Pat Dykes 551 South Washington Street Valporasio, IN 46383 Phone: 219-405-5284 Alegria Campestre Maria Gonzalez 13577 Juniper Rd Argos, IN 46563 Phone: 574-281-2255 Dizon's Foods Erasmo Dixon 2699 McKelvey Rd Maryland Heights St. Louis. M063043 Phone:314-680-0595 Starr Concessions Brandon Starr 2294 Swanson Rd. Portage, IN 46368 Phone: 219-805-4607 West Side Tractor Sales Carl Lueth 25166 State Road 2 South Bend, IN 46619 Michiana Face Painting Sylvia Wilson 1814 Lenninger Ave. Elkhart, IN 46517 Dippin Dots John Patriarca 15 Calle Anacua 1 Brownsville, TX 78520 Phone: 574-232-1416 Phone:574-747-2263 Phone: 956-605-9360 Landers Crafters Fashion Del Cid Georgia Landers Elder Rapaio/Mirna Del Cid 3402 Felician Street 4"Oliver St. Phone: 574-387-7460 Fort Wayne, IN 46803 Phone: 260-710-6008 South Bend, IN 46619 Aetna Twisted Craft Junkies Tim Oyler Amanda Pennington 911 Chestnut St. Apt. 2 402 Park Ave. Anderson, IN 46012 Phone: 765-639-8551 Mishawaka, IN 46545 Phone: 574-303-9362 Child Evangelism AT & T Crystal King Kelly Grimm PO Box 54 2707 Cassopolis St. Argos, IN 46501 Phone:574-315-8746 Elkhart, IN 46514 Phone: 574-346-8512 Aqua Otter Systems Larry Foster Glazzer 11216 Fall Creek Road Suite 126 Flora Cole Indianapolis, IN 46256 Phone: 822-499-6708 1710 N Brookfield St. South Bend. IN 46628 Phone: 574417-1538 Indiana Ribey Bath Planet Kristi Worm -Hunter Aileen Watkins 9870 Greentree Dr. 702 S Logan St. Carmel, IN 46032 Phone: 317-875-7665 Mishawaka, IN 46544 Phone: 574-540-2023 Centurion Exteriors/Roofing Bee Window Steve Thompson Anna Nickell 1943 Lakeview Dr. 115 Shadowlawn Fort Wayne, IN 46808 Phone: 419-551-0267 Fishers, IN 46038 Phone: 317-605-5588 Minix By De, LLC Patriotic Merchandise De' Aviana Holman Patty Framak 4425 Irish Hills Dr. 3B 56730 Via Pisa South Bend, IN 46614 Phone:574-575-1055 Elkhart, IN 46516 Phone:574-361-4330 Coffee & Me Potter's Alley Gifts Lucretia Marsh -Ward Nicolette Potter 2725 Fredrickson St. 1316 Sunwood Dr. South Bend, IN 46628 Phone: 404-749-7701 South Bend, IN 46628 Phone:269-830-4268 Rustic Fisher Creations The Arty People Elizabeth Fisher Samara Dulik 67679 Sycamore Rd. 3924 Miami Street North Liberty, IN 46554 Phone: 574-279-5754 South Bend, IN 46624 Phone:574-301-9744 Comcast/Xfinity Soldier Solutions, LLC Molly Outdo Frank quagliono 2001 York Rd Ste 200 60 Church St. ID Oakbrook, It 60523 Phone: 708-203-9130 Wallingford, CT 06492 Phone: 203-265-9129 Thirty One Gifts Legions of Mary Kim Johnson Sandy Walker 7752 N Mohawk Trail 522 Lowell Wood South Rolling Praire, IN 46371 Phone: 219-778-0623 Mishawaka, IN 465" Phone: 574-259-6215 Cutco Conklin's Custom Baits Rob Steiner Rob RS Kasey Conklin 32Z Houghton Ave. 19659 Brick Rd Olean, Newyork 14760 Phone: 248-231-0291 South Bend, IN 46637 Phone: 574485-8245 Sheila's Simply Chic Boutique/Paparzzi Gorka Graphics and Apparel Sheila Carpenter Kamryn Gorka 24497 Sandpiper to 2123E Surface Ave. Elkhart, IN 46524 Phone: 574-612-0356 Lakeville, IN 46536 Phone: 574-876-2692 Everdry J & M Distributing Katie Whitehouse Amy Adkins 4647 W. Cleveland Rd. 69045 M-62 South Bend, IN 46628 Phone: 574-272-3788 Edwardsburg, MI 49112 Phone: 574-358-1943 Lee's Woodworking Crafts & Jewelry Luxurious Liquids Sandra Lee LaShayla Jones S45 E. 1500 N 3620 Fellow St. Michigan City, IN 46360 Phone: 219-814-3534 South Bend, IN 46614 Phone: 574-300-2102 Lilla Rose Magician Debra S Berndt Kevin Long 63476 Pierson Rd 525 East Douglas Street Apt. 3 Cassopolis, MI 49031 Phone: 269-445-3010 Goshen, IN 46526 Phone: 574-747-5511 October Wind Pink Zebra Cindy Kleckner Julie Reed 518 Gentle Court 1245 Thorn Rd Valparaiso, IN 46385 Phone: 319-617-5439 Walkerton, IN 46574 Phone: 574-514-5698 Pappalohn's Rethink Industrial Solar Nicole Borowski Amanda Mitchell 1812 S Ironwood, IN 27205 Riley Rd. South Bend, IN 46613 Phone: 574-380-5763 North Liberty, IN 46544 Phone: 574-250-8613 Scentsy Screenmobile Tracylones Timothy Johnson 506 Magnolia 2205 S Michigan St. Three Oaks, MI 49128 Phone: 269-332-7845 South Bend, IN 46613 Phone: 630-981-7245 SCM Relaxation Sir Home Improvements Glen Gooddard Bra Smith 3991 Dick Pond Rd. 9151 Shaver Road Myrtle Beach, SC 29588 Phone: 843-213-2632 Portage, MI 49024 Phone: 636-560-5856 St. Joseph County Democratic Party Mary Jo Sullivan 135 South Lafayette Blvd. South Bend, IN 46601 Phone: 574-229-6426 St. Joseph County Police Dept. Samantha Mendenhall 401 W Sample Street South Bend, IN 46601 Phone: 574-245-6540 St. Joseph County Libertarian Party St. Joseph County Right to Life Tim Cotton 2004 Ironwood Circle, Suite 130 63808 State Rd. 23 South Bend, IN 46635 Phone: 574-232-5433 North Liberty, IN 46554 Phone: 574-612-9684 St. Joseph County Republican Party Star Martial Arts PO box 245 Rachel Campagnoli South Bend, IN 46624 Phone: 574-250-3517 5776 N Grape Rd. Suite a48 Mishawaka, IN 46545 Phone: 574-277-5425 Star Maglc Solution Oral Thompson1820 Bovingdon Strikes & Spares Ocoee, FI 34761 Phone: 321-297-4112 Alexis Votava 5419 N Grape Rd Mishawaka, IN 46545 Phone: 574-243-2695 The Runny Pot Global Fair Play Christina McCormick Clix Therapy 421 S. Second St. Suite B Jennifer Grant -Brush Elkhart, IN 46516 Phone: 574-612-0617 PO Box 55061 Norfolk, Va 23505 Phone: 757-646-1073 Urban Essence Adreon Wells Lighthouse Boutique &Jewelry 1319 E Victoria Street Tasha Scott South Bend, IN 46614 Phone: 574-298-7633 421 S 2ntl Suite 204 Elkhart, IN 46516 Phone: 574-346-8512 A � CERTIFICATE OF LIABILITY INSURANCE ;, " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFKATE HOLDER THIS CERTIFICATE DOES NOT AFFIRM 174MY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT MNSTfTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AIITHORGED REPRESENTAME OR PRODUCER AN D THE CERTI RCATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pnlicyges) must have ADDITIONAL INSURED provisions or be endorsed. R SUBROGATION IS WANED, subject to the terms and comfitio1ns of the policy, certain policies may require an endorsement A stalemand on this certificate does not confer rights to the car6ficate holder i n lieu of such endorsement(s). PRODUCER 13�800 Jackson Rd LLC Mishamoa IN 46544 WE cr JessicaRcush PM4XE 5742316514 Mew E"MmN.Lss. IrausH@s InwR rcu E6NE ARFpiNIG CLVERAGE sent WSURERA: K A K Insurance Grou ISUNNED srIOSFPa St Joseph County 4-H Fair, Inc. 5117 Imnmod Road wsuRERe:lntliare FamrrslnwRrca 22824 MSURERc: rsURERo: South Bend IN 46614 INSURERE: WURERF: COVERAGES CERTIFICATE NUMBE11:533293897 RMSION 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 CONTRACT OR OTHER DOCUMENT WGH RESPECT TO WHICH THIS CERTIFICATE MY BE ISSUED OR MY PERTAIN, THE NSURANCE AFFORDED BY THE P ES DESCRIBED HEREIN IS SUBUMT TO All THE TERMS FXCLUSIONSAND CONDITIONSOF SUCHPOLIOES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID OLuMS. son L MEOFIMSIRNICE WOOL Man 1OHCYNIWER PLAID EW NMOM UNNS A X CON®IMLOENENALUOBEIry WMSIMDE OCWR Mywp05016TwN WIW2026 Vlaoao6 EACH OCCURRENCE f1.000000 MINfF TIrRENIT-0 f300000 PD DP loom PERsowusawlwMm 10110000 GENLAGGPEWIEppMpp1ppR.. X ARLESPER: POLICY �,EOT �ILC mNDi GEdRN.AGGMkTE 55.000.000 55000000 f R I mO EUMII ANr AUTO OWem XHEDUUD AUTOS ONLY auras HIRED X NY481 0Nr AUTOS ONLY ALTOSONLY CAP1012112 311W025 W1M026 SMGIE Uvo 11,000A00 X PUILYmJURY(PeviN" E GODLYNMRr A'Mev:NmV s Z' gppERtt MMpGE f f A X UN LLALIM IXQSAND X OCgq CWMSJMDE MK%Om05m6T51m W1W2025 3/1WOM WOVOWJIRENCE fSBm,Om AGGREGATE 55,000,0110 DEO RETENTIMS S D RONEeRSCOWFNWTIDN Mm EN0.0YSINWLIAPIITV YIN MIWRCPRETONPM3RET4EX9:m1VE OFTICQ IVGERFXCL110Em (MmEvbyln Im 3 ae9;beomm CESWPICN CFd£MTCN. bWv NIA MP1002324 WIW2025 W1W2026FI X RNIE El EOLNAWOENT f50%m0 E1.DI3EARE-EAELPIDYE fmDmO ELDNEASE-POU Uaffr f500.000 A MnENenw wi'mm5m6T5m1 311WO26 31IW2026 RenlemavxEryup P:n UmN Dewy° 300,m0 '100,m0 10 m OESCRREpNOF OFERTIpIA/LOI1,1tlN3/YEHCLFi (AISROIBI.AJSIiontl Rnnvla See W.mryb¢v1M¢b¢J%ngn¢pv¢kvpW,¢JI CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRHTHE POUCY PROVISIONS. CI'0Ny of South Bend 2Y/ W. Jefferson Blvd, Suite 1400 S. South Bend IN 46601 AURORUEDIEMMWATME f" 019M2015ACORDCORPORATION. Allrightsmoarved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD