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A`� Q® C `...� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDI 16 g/9/2016 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 Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 PO BOX 11177 South Bend IN 46601-0177 CONTACT Lisa Dausman NAME: X. (800) 814-2122 AX Ne: (800)836-2122 nooalEs'Idausman@gibsonins.com INSURER(S) AFFORDING COVERAGE NAIC0 i:ySURERA :Cincinnati Ins Co 10677 INSURED Rajeev X. & Bimlesh R. Chaudhary 14684 Heatherton Dr Granger IN 46530 INSURER B : INSURERC: INSURER D: INSURER E : INSURER F: rnvco nr_cc CERTIFICATE NIIMRFR•CL168917286 REVISION NUMBER: V 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 Or 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. INISR ITR TYPE OF INSURANCE IN L R POLICY NUMBER MMILDD�Y MMIDDY/YYVY LIMITS R I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE 1XI OCCUR DAMAGE TU-R—ENTED PREMISES (Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 X GL BINDER 10/1/2016 10/1/2016 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP/OP AGG $ 5,000,000 %r POLICY ❑ PRO ❑ LOC JECT Employee Benefits $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED F SCHEDULED AUTOS AUTOS NON-0WNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ WORKERS COMPENSATION PSTER OTH- ATUTE ER AND EMPLOYERS LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory In NH) E. L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schec:ule, may be attached if more space Is required) CITY OF SOUTH BEND IS LISTED AS ADDITIONAL NASD INSURED FOR COLFAX STREET CLOSURE 10/1/16 FOR WEDDING CEREMONY CITY OF SOUTH BEND 227 W JEFFERSON BLVD SOUTH BEND, IN 46601 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gibson Ins Agency/LI n 1988-2014 ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025,,,,anal All rights